Provider Demographics
NPI:1740403773
Name:EDEN, VIOLET ALICE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:ALICE
Last Name:EDEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N 4TH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1472
Mailing Address - Country:US
Mailing Address - Phone:734-776-2284
Mailing Address - Fax:
Practice Address - Street 1:218 N 4TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1472
Practice Address - Country:US
Practice Address - Phone:734-776-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health