Individual
EBONI R BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 PENNSYLVANIA AVE SE, WASHINGTON, DC 20020-2408
(202) 878-6626
Mailing address
18474 BROOKE RD, SANDY SPRING, MD 20860-1406
(301) 252-4253
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
03/08/2023
Last updated
06/07/2023
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