Provider Demographics
NPI:1790028587
Name:EDDINS, ALICIA CATOE (LISW-CP, CACI)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:CATOE
Last Name:EDDINS
Suffix:
Gender:F
Credentials:LISW-CP, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-5148
Mailing Address - Country:US
Mailing Address - Phone:843-623-7062
Mailing Address - Fax:843-623-7112
Practice Address - Street 1:1218 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-5148
Practice Address - Country:US
Practice Address - Phone:843-623-7062
Practice Address - Fax:843-623-7112
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95131041C0700X
SC1308272101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)