Provider Demographics
NPI:1760247597
Name:HAMPTON, EBONY NICOLE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:HAMPTON
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 1:24301 SOUTHLAND DR STE 600
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1554
Mailing Address - Country:US
Mailing Address - Phone:415-286-3590
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR
Practice Address - Street 2:600
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1554
Practice Address - Country:US
Practice Address - Phone:415-474-7310
Practice Address - Fax:510-227-1070
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker