Provider Demographics
NPI:1740674159
Name:EBISON, LORETTA (LPC-A)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:EBISON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8530
Mailing Address - Country:US
Mailing Address - Phone:225-945-3089
Mailing Address - Fax:
Practice Address - Street 1:102 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-8530
Practice Address - Country:US
Practice Address - Phone:225-945-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional