Individual
EBONY COPELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
549B S 19TH ST, NEWARK, NJ 07103-1386
(862) 944-0593
Mailing address
PO BOX 2104, EAST ORANGE, NJ 07019-2104
(862) 944-0593
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NJ
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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