Provider Information for 1235699752
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Ms. EBONY WHITE LCMHC, NCC
Sex: Female
NPI: 1235699752
Last Updated: 2022-09-12
Certification Date: 2022-09-12
Certification Date: 2022-09-12
Details
| Name | Value | ||||||||||||||||
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| NPI | 1235699752 | ||||||||||||||||
| Enumeration Date | 2019-03-21 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 434 LEECREST DR CHARLOTTE, NC 28214-2577 United States Phone: 980-430-9943 | Fax: | ||||||||||||||||
| Primary Practice Address | 10130 MALLARD CREEK RD STE 300 CHARLOTTE, NC 28262-6001 United States Phone: 980-430-9943 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 419 S YORK ST 1243 E DIXON BLVD STE 4 | ||||||||||||||||
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