Anita Rose Hagewood, Licensed Psych Tech
Licensed Psychiatric Technician in Fairfield, CA. Individual provider (NPI-1).
NPI number1356820732
StatusActive
Last updated in NPPESAug 7, 2018
Details
- NPI
- 1356820732
- Entity type
- Individual (NPI-1)
- Name
- Anita Rose Hagewood
- Credential
- Licensed Psych Tech
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 7, 2018
- Last updated
- Aug 7, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 167G00000X | Licensed Psychiatric Technician | PT18280 | CA | Yes |
Practice location
2101 Courage DrFairfield, CA 94533-6717
Phone 707-253-7015
Mailing address
2101 Courage DrFairfield, CA 94533-6717
Phone 707-253-7015
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