Provider Demographics
NPI:1720195464
Name:ECKHART, VICI LYNN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:VICI
Middle Name:LYNN
Last Name:ECKHART
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:FAYETTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6432
Mailing Address - Country:US
Mailing Address - Phone:770-841-8318
Mailing Address - Fax:770-719-7846
Practice Address - Street 1:111 PETROL POINTE
Practice Address - Street 2:SUITE B 3
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1553
Practice Address - Country:US
Practice Address - Phone:770-841-8318
Practice Address - Fax:770-719-7846
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW CSW002904103T00000X
KSLSCSW1186103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist