Provider Demographics
NPI:1336345503
Name:TOLBERT, EBONY LA'ROYA
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:LA'ROYA
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 EDGEWATER CV APT 8
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-9150
Mailing Address - Country:US
Mailing Address - Phone:901-252-1285
Mailing Address - Fax:
Practice Address - Street 1:5515 SHELBY OAKS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7316
Practice Address - Country:US
Practice Address - Phone:901-252-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health