Provider Demographics
NPI:1811609357
Name:EAVES, MARIEL FELICIA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:FELICIA
Last Name:EAVES
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6507
Mailing Address - Country:US
Mailing Address - Phone:919-617-1006
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 5007
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2539
Practice Address - Country:US
Practice Address - Phone:919-748-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical