Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | PS894023255 | CA |
N | 102L00000X | Psychologist | PSY32704 | CA |
N | 103T00000X | Psychologist | PSY32704 | CA |
N | 103G00000X | Clinical Psychologist | PSY32704 | CA |
N | 103TC0700X | Clinical Psychologist | PSY32704 | CA |
Y | 103TC1900X | Counseling Psychologist | 32704 | CA |
N | 103TC1900X | Counseling Psychologist | PSB94023255 | CA |
NPI | 1063793909 |
---|---|
Provider Name | Dr. Laqeishia Sharrice Hagans |
First Address | San Bernardino, CA 92423-2486 |
Second Address | Mission Viejo, CA 92691-6468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 12/08/2021 |