Basic Information
| Provider Information | |||||||||
| NPI: | 1265966576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOAG | ||||||||
| FirstName: | KENSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 E PCH | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623173050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4510 E PCH | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623173050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10095 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.