Provider Demographics
NPI:1770529653
Name:EABON, MICHELLE F (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:F
Last Name:EABON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11244 WAPLES MILL RD
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6040
Mailing Address - Country:US
Mailing Address - Phone:703-691-4204
Mailing Address - Fax:703-691-3595
Practice Address - Street 1:11244 WAPLES MILL RD
Practice Address - Street 2:SUITE G-1
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6040
Practice Address - Country:US
Practice Address - Phone:703-691-4204
Practice Address - Fax:703-691-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001597103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent