Provider Demographics
NPI:1093190050
Name:EDWARDS, EBONEE PERTRICE (MS, CRC, LCMHC, ALC)
Entity type:Individual
Prefix:MRS
First Name:EBONEE
Middle Name:PERTRICE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, CRC, LCMHC, ALC
Other - Prefix:MS
Other - First Name:EBONEE
Other - Middle Name:PERTRICE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CRC, LPCA
Mailing Address - Street 1:615 SAINT GEORGE SQUARE CT
Mailing Address - Street 2:STE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:252-518-5223
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT
Practice Address - Street 2:STE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:252-518-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional