Provider Demographics
NPI:1952407900
Name:EISENHOWER, JAMES WALTER (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTER
Last Name:EISENHOWER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80001411Medicare ID - Type UnspecifiedLCSW