Provider Demographics
NPI:1972191369
Name:DEWEY, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DEWEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WILDERNESS DR APT 139
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2607
Mailing Address - Country:US
Mailing Address - Phone:239-302-5369
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2649
Practice Address - Country:US
Practice Address - Phone:410-730-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05705101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1366585739OtherCOLUMBIA ADDICTIONS CENTER