Individual
HAZEL JAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6714 HIGHWAY 85 # A, RIVERDALE, GA 30274-2383
(510) 415-2089
Mailing address
6714 HIGHWAY 85 # A, RIVERDALE, GA 30274-2383
(510) 415-2089
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
221700000X
Art Therapist
—
—
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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