Healthcare Provider Details

I. General information

NPI: 1629589049
Provider Name (Legal Business Name): CARRIE ANN HAGLUND SUDCCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 CHESTNUT AVE
LONG BEACH CA
90813-1674
US

IV. Provider business mailing address

351 E 6TH ST
LONG BEACH CA
90802-1402
US

V. Phone/Fax

Practice location:
  • Phone: 424-456-8637
  • Fax: 562-591-6134
Mailing address:
  • Phone: 562-435-7350
  • Fax: 562-432-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: