Provider Demographics
NPI:1770299877
Name:GLOVER-EPPS, EBONY N (CSAC, RIC)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:GLOVER-EPPS
Suffix:
Gender:F
Credentials:CSAC, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4902
Mailing Address - Country:US
Mailing Address - Phone:540-525-6155
Mailing Address - Fax:
Practice Address - Street 1:5908 DAIRY RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4902
Practice Address - Country:US
Practice Address - Phone:540-525-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103366101YA0400X
VA0704011835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)