Individual
MS. TAMARA EBNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPRS/CADC INTERN
Contact information
Practice address
725 AIRPORT RD, LAKEWOOD, NJ 08701-5968
(327) 367-4700
Mailing address
16 SHEEPSHEAD DR, TOMS RIVER, NJ 08757-5820
(732) 500-6953
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AD-GTL-21-02309
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487204145
—
NJ
Enumeration date
10/14/2021
Last updated
06/07/2023
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