Provider Demographics
NPI:1568893485
Name:KEBELA, ERIC (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KEBELA
Suffix:
Gender:M
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 1:104 SUNMAR CT APT 2C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5861
Mailing Address - Country:US
Mailing Address - Phone:443-854-1065
Mailing Address - Fax:
Practice Address - Street 1:104 SUNMAR CT APT 2C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5861
Practice Address - Country:US
Practice Address - Phone:443-854-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical