Provider Demographics
NPI:1629152491
Name:EGGLESTON, PRISCILLA W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:W
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 LORNA RD # 2-339
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7404
Mailing Address - Country:US
Mailing Address - Phone:205-999-4335
Mailing Address - Fax:205-803-1280
Practice Address - Street 1:1 INDEPENDENCE PLZ
Practice Address - Street 2:SUITE 716
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2629
Practice Address - Country:US
Practice Address - Phone:205-871-0031
Practice Address - Fax:205-803-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0411C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630917523-005OtherTRICARE
AL51522813OtherBLUECROSS/BLUESHIELD