Individual
EBONY MEDINA WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10601 WALKER ST STE 170, CYPRESS, CA 90630-4759
(248) 765-8679
Mailing address
PO BOX 128, MANHATTAN BEACH, CA 90267-0128
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
125893
CA
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
6801115599
MI
Other
Enumeration date
01/23/2018
Last updated
05/15/2026
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