Provider Demographics
NPI:1407169808
Name:EBERT, JON MARC (LPC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:MARC
Last Name:EBERT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 VICTORIA ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7815
Mailing Address - Country:US
Mailing Address - Phone:804-796-9713
Mailing Address - Fax:
Practice Address - Street 1:6851 COURTHOUSE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-5308
Practice Address - Country:US
Practice Address - Phone:804-715-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional