Healthcare Provider Details

I. General information

NPI: 1154449478
Provider Name (Legal Business Name): MERCEDES E EBANKS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW SUITE 300
WASHINGTON DC
20006-1602
US

IV. Provider business mailing address

13091 SALFORD TER
UPPER MARLBORO MD
20772-6136
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-3117
  • Fax: 202-529-3117
Mailing address:
  • Phone: 301-379-2942
  • Fax: 240-339-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: