Individual
ALISSA D. EASTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7144 E VIRGINIA ST, SUITE C, EVANSVILLE, IN 47715-9125
(812) 479-1242
(812) 479-1330
Mailing address
PO BOX 32, EVANSVILLE, IN 47701-0032
(812) 853-9110
(812) 759-9869
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34006744A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34006744A
IN LCSW LICENSE
IN
Enumeration date
05/01/2017
Last updated
05/01/2017
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