Provider Demographics
NPI:1801390463
Name:HUDSON, EBONY NICHOLE (DSW)
Entity Type:Individual
Prefix:MS
First Name:EBONY
Middle Name:NICHOLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5730
Mailing Address - Country:US
Mailing Address - Phone:510-365-5800
Mailing Address - Fax:
Practice Address - Street 1:982 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2911
Practice Address - Country:US
Practice Address - Phone:415-597-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87476104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No104100000XBehavioral Health & Social Service ProvidersSocial Worker