Provider Demographics
NPI:1720858384
Name:IGWEBUIKE, EBONY LAFEE (CDCA)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:LAFEE
Last Name:IGWEBUIKE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 BASIL WESTERN RD NW
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9207
Mailing Address - Country:US
Mailing Address - Phone:614-989-3124
Mailing Address - Fax:
Practice Address - Street 1:5381 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1116
Practice Address - Country:US
Practice Address - Phone:614-396-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.186920101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)