Provider Demographics
NPI:1306157417
Name:EISEN, MICHAEL (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:EISEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COTTAGEWOODS CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9361
Mailing Address - Country:US
Mailing Address - Phone:919-619-9221
Mailing Address - Fax:
Practice Address - Street 1:22 COTTAGEWOODS CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9361
Practice Address - Country:US
Practice Address - Phone:919-619-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health