Provider Demographics
NPI:1518739804
Name:YEARBY, EBONY T (MS)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:T
Last Name:YEARBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:TRISTICE
Other - Last Name:YEARBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:110 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1025
Mailing Address - Country:US
Mailing Address - Phone:407-734-1273
Mailing Address - Fax:
Practice Address - Street 1:804 KATHY STREET
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH FL
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-898-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health