Individual
MAIJA THACKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.T.
Contact information
Practice address
4151 E FOUNTAIN ST, LONG BEACH, CA 90804-3023
(562) 719-9250
(562) 719-9261
Mailing address
4151 E FOUNTAIN ST, LONG BEACH, CA 90804-3023
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 16398
CA
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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