Provider Demographics
NPI:1760010003
Name:RADCLIFF, ELEANOR E (LCMHCA)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:E
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7544
Mailing Address - Country:US
Mailing Address - Phone:910-378-9461
Mailing Address - Fax:
Practice Address - Street 1:411 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7544
Practice Address - Country:US
Practice Address - Phone:910-378-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health