Healthcare Provider Details

I. General information

NPI: 1508905266
Provider Name (Legal Business Name): EBONY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CALIFORNIA AVE
BAKERSFIELD CA
93304-1405
US

IV. Provider business mailing address

1301 CALIFORNIA AVE
BAKERSFIELD CA
93304-1405
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4756
  • Fax:
Mailing address:
  • Phone: 661-324-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: IRMA CARSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-324-4756