Individual
ANITA ROSE HAGEWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED PSYCH TECH
Contact information
Practice address
2101 COURAGE DR, FAIRFIELD, CA 94533-6717
(707) 253-7015
Mailing address
2101 COURAGE DR, FAIRFIELD, CA 94533-6717
(707) 253-7015
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT18280
CA
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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