Provider Demographics
NPI:1013329960
Name:WHITE, EBONY (NCC, LPC, ACS)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NCC, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1412
Mailing Address - Country:US
Mailing Address - Phone:609-599-1494
Mailing Address - Fax:
Practice Address - Street 1:802 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1412
Practice Address - Country:US
Practice Address - Phone:609-599-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00490500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health