Provider Demographics
NPI:1942560032
Name:ROCKER, EBONE LAVONNE (LPC)
Entity Type:Individual
Prefix:
First Name:EBONE
Middle Name:LAVONNE
Last Name:ROCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EBONE
Other - Middle Name:LAVONE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:5804 DOCKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0600
Mailing Address - Country:US
Mailing Address - Phone:301-378-6342
Mailing Address - Fax:
Practice Address - Street 1:1318 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5482
Practice Address - Country:US
Practice Address - Phone:301-378-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4299101YP2500X
NC9494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional