Individual
ADDISON HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
Mailing address
1900 ROYALTY DR STE 180, POMONA, CA 91767-3046
(909) 623-6131
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
106799
CA
171M00000X
Case Manager/Care Coordinator
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2007
Last updated
04/02/2024
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