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Provider Information for 1861057234


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EILEEN ALEXANDRIA CHASE M.S., Esq.


Other Names:  
Other Name: 
ANDREA CHASE M.S., Esq.

Sex: Female

NPI: 1861057234
Last Updated: 2024-02-05
Certification Date: 2024-02-05

Details

NameValue
NPI1861057234
Enumeration Date2019-05-01
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 391 BROAD ST NW # 201
CLEVELAND, TN 37311-5039
United States

Phone: 423-790-3747 | Fax:
 
Primary Practice Address 391 BROAD ST NW STE 201
CLEVELAND, TN 37311-5039
United States

Phone: 423-790-3747 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDTNQ022498
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthTN6474