Provider Demographics
NPI:1639783574
Name:EVIDENCE BASED CONSULTATION LLC EBC
Entity Type:Organization
Organization Name:EVIDENCE BASED CONSULTATION LLC EBC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-443-4924
Mailing Address - Street 1:43803 MICHENER DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5807
Mailing Address - Country:US
Mailing Address - Phone:703-443-4924
Mailing Address - Fax:703-775-1560
Practice Address - Street 1:43803 MICHENER DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5807
Practice Address - Country:US
Practice Address - Phone:703-443-4924
Practice Address - Fax:703-775-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty