Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY28862 | CA |
Y | 103T00000X | Psychologist | PSY28862 | CA |
NPI | 1003222803 |
---|---|
Provider Name | Brandi Hawk |
First Address | Sacramento, CA 95820-2165 |
Second Address | Sacramento, CA 95820-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 22/12/2016 |