Provider Demographics
NPI:1417796707
Name:BELLE, EBONEE (LCMHCA)
Entity type:Individual
Prefix:
First Name:EBONEE
Middle Name:
Last Name:BELLE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-3549
Mailing Address - Country:US
Mailing Address - Phone:910-257-1056
Mailing Address - Fax:
Practice Address - Street 1:2931 BREEZEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5281
Practice Address - Country:US
Practice Address - Phone:910-748-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health