Provider Demographics
NPI:1255025524
Name:KNITTEL, ELI DOUGLAS (LMSW)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:DOUGLAS
Last Name:KNITTEL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 REGENTS CROSSE LN APT 7C
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5592
Mailing Address - Country:US
Mailing Address - Phone:757-333-1722
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BOULEVARD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903003830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker