Healthcare Provider Details

I. General information

NPI: 1306751417
Provider Name (Legal Business Name): TIMBER DAWN GOAD-HANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 ACACIA AVE APT 88
GARDEN GROVE CA
92841-5265
US

IV. Provider business mailing address

9900 ACACIA AVE APT 88
GARDEN GROVE CA
92841-5265
US

V. Phone/Fax

Practice location:
  • Phone: 657-618-7712
  • Fax: 657-618-7712
Mailing address:
  • Phone:
  • Fax: 657-618-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1577620824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: