Provider Demographics
NPI:1841728748
Name:EDWARDS, EBONY SHAUVON (LBA, BCBA)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:SHAUVON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5300
Mailing Address - Country:US
Mailing Address - Phone:910-493-3555
Mailing Address - Fax:910-493-3520
Practice Address - Street 1:920 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5300
Practice Address - Country:US
Practice Address - Phone:910-493-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician