=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972004034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABIGAIL R. HITCHEN, PSYD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2018
-----------------------------------------------------
Last Update Date | 02/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9666 BUSINESSPARK AVE STE 202
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92131-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-376-7195
-----------------------------------------------------
Fax | 844-364-4331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9666 BUSINESSPARK AVE STE 202
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92131-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-376-7195
-----------------------------------------------------
Fax | 844-364-4331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ABIGAIL R. HITCHEN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 858-376-7195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY25146
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------