Provider Demographics
NPI:1336273176
Name:MCCANN, EILEEN (LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 CABIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-9374
Mailing Address - Country:US
Mailing Address - Phone:850-656-7348
Mailing Address - Fax:
Practice Address - Street 1:1621 METROPOLITAN BLVD STE D
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3792
Practice Address - Country:US
Practice Address - Phone:850-386-9313
Practice Address - Fax:850-422-6469
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health