Provider Demographics
NPI:1467931808
Name:ENGLISH, EBONNE
Entity Type:Individual
Prefix:
First Name:EBONNE
Middle Name:
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 SOUTHFIELD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2851
Mailing Address - Country:US
Mailing Address - Phone:248-242-5545
Mailing Address - Fax:
Practice Address - Street 1:24100 SOUTHFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2851
Practice Address - Country:US
Practice Address - Phone:248-242-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI6401012959101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician