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1417619263
SHANE DOUGLAS HAGAN
VALLEJO, CA
NPI
1417619263
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2021-10-08
Last Update Date
2021-10-08
Business Address
SHANE DOUGLAS HAGAN
1149 WARREN AVE
VALLEJO, CA 94591-7512
Phone number: 707-552-5295
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Mailing Address
SHANE DOUGLAS HAGAN
1149 WARREN AVE
VALLEJO, CA 94591-7512
Phone number: 707-552-5295
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