Provider Demographics
NPI:1215654868
Name:IHEANACHO, EBONY C (PHD)
Entity type:Individual
Prefix:DR
First Name:EBONY
Middle Name:C
Last Name:IHEANACHO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 RAY WEILAND DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3251
Mailing Address - Country:US
Mailing Address - Phone:225-800-2775
Mailing Address - Fax:
Practice Address - Street 1:3009 RAY WEILAND DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3251
Practice Address - Country:US
Practice Address - Phone:225-800-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4788106H00000X
LA1436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty