Individual
EBONY MINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8325 KELWOOD AVE, BATON ROUGE, LA 70806
(225) 238-5498
Mailing address
9420 LINDALE AVE, BATON ROUGE, LA 70815-4161
(225) 442-3540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
009109825
LA
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/25/2015
Last updated
09/04/2018
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