Provider Demographics
NPI:1871122432
Name:EISELE, ILSE (LCPC, LGPC)
Entity type:Individual
Prefix:
First Name:ILSE
Middle Name:
Last Name:EISELE
Suffix:
Gender:F
Credentials:LCPC, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 UPSHUR STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:240-305-7526
Mailing Address - Fax:
Practice Address - Street 1:1425 UNIVERSITY BLVD E STE 245
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4646
Practice Address - Country:US
Practice Address - Phone:240-305-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00519101YP2500X
MDLC10266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional