Provider Demographics
NPI:1982913398
Name:CLARKE, EBONI TASHLIN (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:TASHLIN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ADVANCEMENT AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6490
Mailing Address - Country:US
Mailing Address - Phone:313-410-1871
Mailing Address - Fax:
Practice Address - Street 1:517 ADVANCEMENT AVE APT 4
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6490
Practice Address - Country:US
Practice Address - Phone:313-410-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010894461041C0700X
NCC0073451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical