Provider Demographics
NPI:1053885210
Name:YELDER, EBONY (LPC)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:YELDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 KINGSBORO RD NE APT 524
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3305
Mailing Address - Country:US
Mailing Address - Phone:404-645-3645
Mailing Address - Fax:
Practice Address - Street 1:3460 KINGSBORO RD NE APT 524
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3305
Practice Address - Country:US
Practice Address - Phone:404-645-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional