Provider Demographics
NPI:1851043616
Name:LOVELACE, EBONI S
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:S
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 19TH ST N STE 2176
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3161
Mailing Address - Country:US
Mailing Address - Phone:205-460-9855
Mailing Address - Fax:
Practice Address - Street 1:120 19TH ST N STE 2176
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3161
Practice Address - Country:US
Practice Address - Phone:205-460-9855
Practice Address - Fax:205-460-9855
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator