Provider Demographics
NPI:1619652302
Name:EATON, ANNA PEARL (MED, NCC, LCMHCA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:PEARL
Last Name:EATON
Suffix:
Gender:F
Credentials:MED, NCC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S FIRESTONE ST
Mailing Address - Street 2:APT 339
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:980-251-6054
Mailing Address - Fax:
Practice Address - Street 1:1558 UNION RD STE G
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2215
Practice Address - Country:US
Practice Address - Phone:980-251-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health