Healthcare Provider Details

I. General information

NPI: 1922334341
Provider Name (Legal Business Name): ANNA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24051 AMADOR ST
HAYWARD CA
94544-1201
US

IV. Provider business mailing address

PO BOX 4217
HAYWARD CA
94540-4217
US

V. Phone/Fax

Practice location:
  • Phone: 510-935-3858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT83288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: