Provider Demographics
NPI:1477672756
Name:EIDSON, FAITH MEGAN (MSW)
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:MEGAN
Last Name:EIDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 COPPER SKY DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6950
Mailing Address - Country:US
Mailing Address - Phone:520-452-9784
Mailing Address - Fax:
Practice Address - Street 1:1939 FRONTAGE RD STE A
Practice Address - Street 2:SUITE 200
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4638
Practice Address - Country:US
Practice Address - Phone:520-452-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856001041C0700X
AZLCSW-124591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical