MEDICARE: EBONY WILMORE

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	101YS0200X	School Counselor		SC
2	101YP2500X	Professional Counselor	6237	SC

General Provider Information

NPI Number	:	1295587103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY WILMORE

Provider Business Mailing Address
First Line	:	916 HOLLAND RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9716
Country	:	US
Telephone Number	:	803-209-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 HOLLAND RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9716
Country	:	US
Telephone Number	:	803-209-4696
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “ EBONY WILMORE ” Practice Location

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