Provider Demographics
NPI:1194608554
Name:EILAND, EBONI LYNNE
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:LYNNE
Last Name:EILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 BRICE RD UNIT 572
Mailing Address - Street 2:
Mailing Address - City:BRICE
Mailing Address - State:OH
Mailing Address - Zip Code:43109-7529
Mailing Address - Country:US
Mailing Address - Phone:614-843-5242
Mailing Address - Fax:
Practice Address - Street 1:973 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2342
Practice Address - Country:US
Practice Address - Phone:614-843-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 104100000X, 101YM0800X
OH172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist