Provider Demographics
NPI:1851808885
Name:STUCKEY, EBONY JONES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:JONES
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 TRAFALGAR WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3211
Mailing Address - Country:US
Mailing Address - Phone:478-595-1952
Mailing Address - Fax:
Practice Address - Street 1:1451 TRAFALGAR WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3211
Practice Address - Country:US
Practice Address - Phone:478-595-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
GACSW0073661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171W00000XOther Service ProvidersContractor