| Ebtide Counseling Group, Inc | |
|
3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 | |
| (904) 615-9037 | |
| Not Available |
| Full Name | Ebtide Counseling Group, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 3100 University Blvd S Ste 218, Jacksonville, Florida |
| Authorized Official Name and Position | Ebony Davis (OWNER) |
| Authorized Official Contact | 9046159037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebtide Counseling Group, Inc 3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 Ph: (904) 615-9037 | Ebtide Counseling Group, Inc 3100 University Blvd S Ste 218 Jacksonville FL 32216-2727 Ph: (904) 615-9037 |
| NPI Number | 1144871351 |
|---|---|
| Provider Enumeration Date | 09/28/2019 |
| Last Update Date | 09/28/2019 |
| Medicare PECOS PAC ID | 8527497809 |
|---|---|
| Medicare Enrollment ID | O20200408000792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144871351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ebony R Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891293692 PECOS PAC ID: 5294096061 Enrollment ID: I20180719002594 |
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