Provider Demographics
NPI:1538820873
Name:BOONE, EBONY SWAIN (RIC)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:SWAIN
Last Name:BOONE
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5239
Mailing Address - Country:US
Mailing Address - Phone:757-717-6002
Mailing Address - Fax:
Practice Address - Street 1:3630 S PLAZA TRL STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3364
Practice Address - Country:US
Practice Address - Phone:757-306-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health