Provider Demographics
NPI:1073009379
Name:MICHAEL, ELI (LCSW, CDC1)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:LCSW, CDC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ARCTIC BLVD
Mailing Address - Street 2:STE 201 PMB 1043
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4579
Mailing Address - Country:US
Mailing Address - Phone:907-268-4234
Mailing Address - Fax:877-907-0952
Practice Address - Street 1:821 N ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3285
Practice Address - Country:US
Practice Address - Phone:907-268-4234
Practice Address - Fax:877-907-0952
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4582101YA0400X
AK104100000X
AK1724401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker