Basic Information
| Provider Information | |||||||||
| NPI: | 1598191546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBBE | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LCSW-A, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1409 PINCKNEY ST | ||||||||
| Address2: | |||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284722220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106410600 | ||||||||
| FaxNumber: | 9106414178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 S 17TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107919625 | ||||||||
| FaxNumber: | 9107929799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P006940 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 3507-A | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.