Individual
MS. EBONY WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, RPT, PHD
Contact information
Practice address
7572 N CHERRYVALE BLVD APT 204, CHERRY VALLEY, IL 61016-9305
(702) 572-8535
Mailing address
7572 N CHERRYVALE BLVD APT 204, CHERRY VALLEY, IL 61016-9305
(702) 572-8535
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166.001541
IL
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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