Provider Demographics
NPI:1518566801
Name:MIDDLETON, EBONY NICOLE (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 LIBERTYS DELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6351
Mailing Address - Country:US
Mailing Address - Phone:717-339-8338
Mailing Address - Fax:
Practice Address - Street 1:900 BESTGATE RD STE 210
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7922
Practice Address - Country:US
Practice Address - Phone:717-339-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26389101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty