Provider Demographics
NPI:1568010833
Name:SMITH, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:SMITH
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 1:25 ALLEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2633
Mailing Address - Country:US
Mailing Address - Phone:510-247-8235
Mailing Address - Fax:510-467-6470
Practice Address - Street 1:25 ALLEN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:408-364-7052
Practice Address - Fax:510-467-6470
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor