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General NPI Number Information
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NPI Number | 1063799187
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Entity Type | Individual
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Provider Name | EBONY L DAVIDSON LPC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 629 JEWETT AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2836
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Country | US
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Telephone | 850-264-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 OLDFIELD DR
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City | MONROE
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State | NC
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Zip | 28110-5400
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Country | US
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Telephone | 203-423-9541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3765
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License Number State | CT
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