Individual
EBONY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3800 COOLIDGE AVE, OAKLAND, CA 94602-3311
(510) 482-2244
Mailing address
4712 FOOTHILL BLVD, OAKLAND, CA 94601-5350
(603) 339-6632
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-DEGOQU
CA
Other
Enumeration date
06/10/2024
Last updated
06/23/2025
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