1073126462 NPI number — MS. CAROL JOY EASTON LCSW, CADC

Table of content: MS. CAROL JOY EASTON LCSW, CADC (NPI 1073126462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073126462 NPI number — MS. CAROL JOY EASTON LCSW, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTON
Provider First Name:
CAROL
Provider Middle Name:
JOY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
CAROL
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LBSW, CADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073126462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PINES BEHAVIORAL HEALTH
Provider Second Line Business Mailing Address:
200 VISTA DR.
Provider Business Mailing Address City Name:
COLDWATER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49036-1776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-278-2129
Provider Business Mailing Address Fax Number:
517-279-8172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PINES BEHAVIORAL HEALTH
Provider Second Line Business Practice Location Address:
200 VISTA DR.
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-1776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-278-2129
Provider Business Practice Location Address Fax Number:
517-279-8172
Provider Enumeration Date:
08/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  6802084008 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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