Provider Demographics
NPI:1083199467
Name:CRANE, EBONY SHIANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:EBONY
Middle Name:SHIANNE
Last Name:CRANE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4593 TABOR RD NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9329
Mailing Address - Country:US
Mailing Address - Phone:616-930-6944
Mailing Address - Fax:
Practice Address - Street 1:2335 BURTON ST SE STE 210
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4669
Practice Address - Country:US
Practice Address - Phone:616-236-3600
Practice Address - Fax:616-369-1449
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108286104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker