MEDICARE: MISS EBONY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1063275972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISS EBONY LPC

Provider Business Mailing Address
First Line	:	652 BUSH RIVER RD STE 217
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7537
Country	:	US
Telephone Number	:	803-339-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 HERIOT ST
Second Line	:
City	:	MANNING
State	:	SC
Zip	:	29102
Country	:	US
Telephone Number	:	803-339-2221
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBONY LANGHORNE
Credential	:
Telephone Number	:	803-339-2221

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	06/04/2026

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Directions to “MISS EBONY LPC ” Practice Location

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