Provider Demographics
NPI:1568950525
Name:EBERLY, NINFA OFELIA (CDCA)
Entity Type:Individual
Prefix:
First Name:NINFA
Middle Name:OFELIA
Last Name:EBERLY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2407
Mailing Address - Country:US
Mailing Address - Phone:419-334-4644
Mailing Address - Fax:419-334-4356
Practice Address - Street 1:206 N CLOVER ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2407
Practice Address - Country:US
Practice Address - Phone:419-334-4644
Practice Address - Fax:419-334-4356
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)