Provider Demographics
NPI:1144192303
Name:EBOLE, EKPEN DORIS
Entity type:Individual
Prefix:
First Name:EKPEN
Middle Name:DORIS
Last Name:EBOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 E RALEIGH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3552
Practice Address - Country:US
Practice Address - Phone:616-617-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0218601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty