Provider Demographics
NPI:1063710077
Name:EIKENBERG, CHELSEA ANN (MA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:EIKENBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PRESTON EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8433
Mailing Address - Country:US
Mailing Address - Phone:336-517-7337
Mailing Address - Fax:855-797-9587
Practice Address - Street 1:130 PRESTON EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8433
Practice Address - Country:US
Practice Address - Phone:336-517-7337
Practice Address - Fax:855-797-9587
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7420Medicaid
CA7068Medicaid