Provider Demographics
NPI:1588872204
Name:EADER, JOSEPH MORRIS-WILLIAM (LPC, LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MORRIS-WILLIAM
Last Name:EADER
Suffix:
Gender:M
Credentials:LPC, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 HICKORY NECK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-8732
Mailing Address - Country:US
Mailing Address - Phone:757-940-5009
Mailing Address - Fax:
Practice Address - Street 1:3435 HICKORY NECK BLVD
Practice Address - Street 2:
Practice Address - City:TOANO
Practice Address - State:VA
Practice Address - Zip Code:23168-8732
Practice Address - Country:US
Practice Address - Phone:757-940-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
VA0701007576101YP2500X
SC5365101YP2500X
NC11611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC3337Medicare ID - Type Unspecified