Healthcare Provider Details

I. General information

NPI: 1902221708
Provider Name (Legal Business Name): EBONI WINFORD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EBONI CHANEL HEDGSPETH

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 MARTIN LUTHER KING JR AVE
KNOXVILLE TN
37915-1570
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPARTMENT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-6097
  • Fax: 865-540-1615
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP3163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: