Provider Demographics
NPI:1154449478
Name:EBANKS, MERCEDES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:E
Last Name:EBANKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13091 SALFORD TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6136
Mailing Address - Country:US
Mailing Address - Phone:301-379-2942
Mailing Address - Fax:240-339-1334
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:202-529-3117
Practice Address - Fax:202-529-3117
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool