Provider Demographics
NPI:1114237989
Name:STUTSON, EBONY (LPC)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:STUTSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11156 CANAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-5816
Mailing Address - Country:US
Mailing Address - Phone:513-772-6166
Mailing Address - Fax:513-772-6177
Practice Address - Street 1:11156 CANAL RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-5816
Practice Address - Country:US
Practice Address - Phone:513-772-6166
Practice Address - Fax:513-772-6177
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002549101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor