Organization
EBONY THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARA GENINE EDWARDS CPC (OFFICIAL DELEGATE)
(314) 791-2606
Entity
Organization
Contact information
Practice address
3751 PENNRIDGE DR STE 119, BRIDGETON, MO 63044-1244
(314) 791-2606
Mailing address
3751 PENNRIDGE DR STE 119, BRIDGETON, MO 63044-1244
(314) 443-7776
(314) 735-4377
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/26/2020
Last updated
11/17/2020
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