Provider Demographics
NPI:1629148697
Name:EATON, VICKI LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LEE
Last Name:EATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LEE
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 W JEROME CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5939
Mailing Address - Country:US
Mailing Address - Phone:847-849-7140
Mailing Address - Fax:
Practice Address - Street 1:825 W JEROME CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5939
Practice Address - Country:US
Practice Address - Phone:847-849-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0057211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626654OtherBLUE CROSS BLUE SHIELD
IL081156OtherVALUE OPTIONS