Individual
EBONY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 W MARCH LN, STOCKTON, CA 95207-6462
(916) 913-0822
Mailing address
2105 W MARCH LN STE 2, STOCKTON, CA 95207-6422
(916) 913-0822
(510) 467-6470
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/29/2019
Last updated
06/03/2025
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