Individual
EBONI MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4121 LINCOLN ST APT 2, GARY, IN 46408-2560
(872) 301-0893
Mailing address
4121 LINCOLN ST APT 2, GARY, IN 46408-2560
(872) 301-0893
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
0704013232
VA
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
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