Provider Demographics
NPI:1720558901
Name:VELASQUEZ-WALTERS, EILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:VELASQUEZ-WALTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEWITT ST # 10
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 DEWITT ST # 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5649
Practice Address - Country:US
Practice Address - Phone:910-939-1127
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008105A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical