Active NPI
Ebonye Dawn Debose-Moore, LPC
- Professional Counselor
- Ridgeland, MS
National Provider Identifier
1912725797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2070
- Practice address
- 731 S Pear Orchard Rd Ste 51
Ridgeland, MS 39157-4841 - Phone
- (601) 981-0725
- NPI assigned
- Sep 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2070 | MS | |
| Professional Counselor | 101YP2500X | 2070 | MS | Primary |
Addresses
Primary practice location
731 S Pear Orchard Rd Ste 51
Ridgeland, MS 39157-4841
Mailing address
802 Fairfax Cir
Jackson, MS 39211-4240
Phone (601) 672-6943
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2070 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728345600000",
"number": "1912725797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 FAIRFAX CIR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392114240",
"telephone_number": "601-672-6943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 S PEAR ORCHARD RD STE 51",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391574841",
"telephone_number": "601-981-0725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBOSE-MOORE",
"first_name": "EBONYE",
"middle_name": "DAWN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-30",
"last_updated": "2024-10-08",
"certification_date": "2024-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MS",
"license": "2070",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "2070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgeland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.