Provider Demographics
NPI:1184977696
Name:EIFERT, CAROL A (MS, PCC, LSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:EIFERT
Suffix:
Gender:F
Credentials:MS, PCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 BENNERT DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2510
Mailing Address - Country:US
Mailing Address - Phone:937-603-3708
Mailing Address - Fax:
Practice Address - Street 1:1349 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4925
Practice Address - Country:US
Practice Address - Phone:937-603-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700061101YP2500X
OHS0006817104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker