Provider Demographics
NPI:1720293772
Name:DR. JAMES W. EISENHOWER, PH.D, LCSW, LLC
Entity Type:Organization
Organization Name:DR. JAMES W. EISENHOWER, PH.D, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EISENHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-373-6051
Mailing Address - Street 1:281 INDEPENDENCE BLVD
Mailing Address - Street 2:#305
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2986
Mailing Address - Country:US
Mailing Address - Phone:757-373-6051
Mailing Address - Fax:757-497-1327
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:#305
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-373-6051
Practice Address - Fax:757-497-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952407900Medicaid