MEDICARE: MS. EBONI CLIPPER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC8459	MD

General Provider Information

NPI Number	:	1083063887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EBONI CLIPPER LCPC

Provider Business Mailing Address
First Line	:	845 QUINCE ORCHARD BLVD STE F
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1676
Country	:	US
Telephone Number	:	301-769-5878
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 QUINCE ORCHARD BLVD STE F
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1676
Country	:	US
Telephone Number	:	301-769-5878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	07/18/2022

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