Provider Demographics
NPI:1740310325
Name:NARDIN, EILEEN BLUM (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:BLUM
Last Name:NARDIN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4268
Mailing Address - Country:US
Mailing Address - Phone:919-367-0404
Mailing Address - Fax:
Practice Address - Street 1:1071 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4268
Practice Address - Country:US
Practice Address - Phone:919-367-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1258HOtherBCBS OF NC
NC2879204Medicare ID - Type Unspecified