Healthcare Provider Details

I. General information

NPI: 1871418962
Provider Name (Legal Business Name): EBONIE T COPELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WHITE HORSE RD
VOORHEES NJ
08043-4406
US

IV. Provider business mailing address

1000 WHITE HORSE RD STE 102
VOORHEES NJ
08043-4407
US

V. Phone/Fax

Practice location:
  • Phone: 877-222-0399
  • Fax:
Mailing address:
  • Phone: 877-222-0399
  • Fax: 888-979-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: