Provider Demographics
NPI:1124187687
Name:EBBITT, MARY JOAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOAN
Last Name:EBBITT
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 1:128 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2745
Mailing Address - Country:US
Mailing Address - Phone:516-266-6666
Mailing Address - Fax:517-266-6666
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2745
Practice Address - Country:US
Practice Address - Phone:516-266-6666
Practice Address - Fax:517-266-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010756831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical