Provider Demographics
NPI:1023735040
Name:VAN DER EIJK, MEGHAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:VAN DER EIJK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:FITZGIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2404 EAGLES VIEW PL
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3559
Mailing Address - Country:US
Mailing Address - Phone:757-515-2610
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040110271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical