Provider Demographics
NPI:1144739970
Name:MITCHELL, EBONIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:EBONIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 ELLERSLIE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3501
Mailing Address - Country:US
Mailing Address - Phone:443-570-0502
Mailing Address - Fax:
Practice Address - Street 1:414 LYMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3511
Practice Address - Country:US
Practice Address - Phone:443-898-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical