Provider Demographics
NPI:1922713874
Name:AULL, EBONY SHANICE (MSW)
Entity Type:Individual
Prefix:MS
First Name:EBONY
Middle Name:SHANICE
Last Name:AULL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2669
Mailing Address - Country:US
Mailing Address - Phone:301-247-8198
Mailing Address - Fax:
Practice Address - Street 1:632 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2669
Practice Address - Country:US
Practice Address - Phone:301-247-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50081073104100000X
MD21673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker