Provider Demographics
NPI:1902221708
Name:WINFORD, EBONI (PHD)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:WINFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EBONI
Other - Middle Name:CHANEL
Other - Last Name:HEDGSPETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2202 MARTIN LUTHER KING JR AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37915-1570
Practice Address - Country:US
Practice Address - Phone:865-522-6097
Practice Address - Fax:865-540-1615
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP3163103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth