Individual
EBONYE DAWN DEBOSE-MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
731 S PEAR ORCHARD RD STE 51, RIDGELAND, MS 39157-4841
(601) 981-0725
Mailing address
802 FAIRFAX CIR, JACKSON, MS 39211-4240
(601) 672-6943
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2070
MS
101YP2500X
Professional Counselor
Primary
2070
MS
Other
Enumeration date
09/30/2024
Last updated
10/08/2024
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