Provider Demographics
NPI:1194290056
Name:DEPRIEST, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CARLTON DAVIDSON LN
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2924
Mailing Address - Country:US
Mailing Address - Phone:740-533-0648
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:225 CARLTON DAVIDSON LN
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2924
Practice Address - Country:US
Practice Address - Phone:740-533-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool