Provider Demographics
NPI:1275060857
Name:CROUELL, EBONY (LCAS-A)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:CROUELL
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2542
Mailing Address - Country:US
Mailing Address - Phone:522-268-4695
Mailing Address - Fax:
Practice Address - Street 1:1412 SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2542
Practice Address - Country:US
Practice Address - Phone:252-268-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)