Thecle Ebanks
Social Worker, Clinical in Fort Eustis, VA. Individual provider (NPI-1).
NPI number1225755093
StatusActive
Last updated in NPPESAug 17, 2024
Details
- NPI
- 1225755093
- Entity type
- Individual (NPI-1)
- Name
- Thecle Ebanks
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 24, 2022
- Certification date
- Aug 17, 2024
- Last updated
- Aug 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 0904014407 | VA | Yes |
| 1041C0700X | Social Worker, Clinical | 8308 | TN |
Practice location
576 Jefferson AveFort Eustis, VA 23604-1373
Phone 757-314-7500
Mailing address
576 Jefferson AveFort Eustis, VA 23604-1373
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