Provider Demographics
NPI:1831875624
Name:WHITE, EBONY (LPC)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:WHITE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:765 ROUTE 70 E BLDG A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4771
Mailing Address - Fax:856-797-4785
Practice Address - Street 1:765 ROUTE 70 E BLDG A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2341
Practice Address - Country:US
Practice Address - Phone:856-797-4771
Practice Address - Fax:856-797-4785
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00513400101YM0800X, 104100000X
NJ37PC01098300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker