Provider Demographics
NPI:1780210286
Name:MCAFEE, EBONIE (APC)
Entity Type:Individual
Prefix:
First Name:EBONIE
Middle Name:
Last Name:MCAFEE
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 ROLLING VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4011
Mailing Address - Country:US
Mailing Address - Phone:404-583-1249
Mailing Address - Fax:
Practice Address - Street 1:1496 ROLLING VIEW WAY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4011
Practice Address - Country:US
Practice Address - Phone:404-583-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health