Provider Demographics
NPI:1083063887
Name:CLIPPER, EBONI (LCPC)
Entity Type:Individual
Prefix:MS
First Name:EBONI
Middle Name:
Last Name:CLIPPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 QUINCE ORCHARD BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1676
Mailing Address - Country:US
Mailing Address - Phone:301-769-5878
Mailing Address - Fax:
Practice Address - Street 1:845 QUINCE ORCHARD BLVD STE F
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1676
Practice Address - Country:US
Practice Address - Phone:301-769-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional