Healthcare Provider Details

I. General information

NPI: 1578299657
Provider Name (Legal Business Name): LANIQUA HOARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 CHERRY AVE
LONG BEACH CA
90805-4405
US

IV. Provider business mailing address

5861 CHERRY AVE
LONG BEACH CA
90805-4405
US

V. Phone/Fax

Practice location:
  • Phone: 562-676-4259
  • Fax:
Mailing address:
  • Phone: 562-676-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149632
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: