Provider Demographics
NPI:1912790924
Name:DOILICHO, EKYOMA BEYENE
Entity type:Individual
Prefix:
First Name:EKYOMA
Middle Name:BEYENE
Last Name:DOILICHO
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 1:8514 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-6458
Mailing Address - Country:US
Mailing Address - Phone:817-501-4929
Mailing Address - Fax:817-501-4929
Practice Address - Street 1:8514 TUPELO DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-6458
Practice Address - Country:US
Practice Address - Phone:817-501-4929
Practice Address - Fax:817-501-4929
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW184831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical