Provider Demographics
NPI:1184251555
Name:EICHELBERGER, YASMEEN PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:YASMEEN
Middle Name:PATRICIA
Last Name:EICHELBERGER
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 1:4226 SUMMERTON DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8738
Mailing Address - Country:US
Mailing Address - Phone:601-248-7561
Mailing Address - Fax:855-387-8203
Practice Address - Street 1:510 GEORGE ST
Practice Address - Street 2:STE 201
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3027
Practice Address - Country:US
Practice Address - Phone:601-248-7561
Practice Address - Fax:855-387-8203
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MSC50091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty