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Individual

EBONY MACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
2041 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20020-7024
(202) 547-8450
Mailing address
11315 KETTERING TER, UPPER MARLBORO, MD 20774-1567
(301) 974-2286

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSYA00343
DC
103TC0700X
Clinical Psychologist
PSYA00343
DC

Other

Enumeration date
01/27/2020
Last updated
09/28/2023
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