Provider Demographics
NPI:1598193716
Name:EASON, ATHALIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ATHALIA
Middle Name:
Last Name:EASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 BOURBON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7348
Mailing Address - Country:US
Mailing Address - Phone:540-656-3662
Mailing Address - Fax:888-770-0014
Practice Address - Street 1:3329 BOURBON ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7348
Practice Address - Country:US
Practice Address - Phone:540-656-3662
Practice Address - Fax:888-770-0014
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005618101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health