Provider Demographics
NPI:1992722631
Name:EILENBERGER, JILL C (LCSW, LMFT)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:C
Last Name:EILENBERGER
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11692
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28220-1692
Mailing Address - Country:US
Mailing Address - Phone:704-591-0648
Mailing Address - Fax:704-943-0768
Practice Address - Street 1:4108 PARK RD
Practice Address - Street 2:STE 322
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2259
Practice Address - Country:US
Practice Address - Phone:704-591-0648
Practice Address - Fax:704-943-0768
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3025FOtherBCBS