Thecle Ebanks

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904014407 Issued in VA

Practice address

576 Jefferson Ave
Fort Eustis, VA 23604-1373

Phone

(757) 314-7500

NPI assigned

Oct 24, 2022

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 17, 2024.

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723852800000",
    "number": "1225755093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373",
            "telephone_number": "757-314-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBANKS",
        "first_name": "THECLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-24",
        "last_updated": "2024-08-17",
        "certification_date": "2024-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "8308",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904014407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Donohue, PA-C
• Paul Duch, M.D.
• John Edward Dulski, DDS
• Spenser Austin Durst, DDS
• Nicole Dye, PT, DPT
• Nkechi Trudy Ekwueme
• Joseph Soriano Estrada, MPAS, PA-C
• Brandy Alana Etter, RN CMGT-BC
• Gail A. Evans, PHYSICIAN ASSISTANT
• Michael Thomas Evans, DDS

• All providers in Fort Eustis, VA
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.