Provider Demographics
NPI:1902568702
Name:EADES, MARK PATRICK (PHD, NCLMHCS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PATRICK
Last Name:EADES
Suffix:
Gender:M
Credentials:PHD, NCLMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 PRESERVATION FOREST LN
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-0017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4665 PRESERVATION FOREST LN
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-0017
Practice Address - Country:US
Practice Address - Phone:919-610-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health