Provider Demographics
NPI:1093877177
Name:FAULKNER, HAZEL FAYE (BHC,RASI)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:FAYE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:BHC,RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2704
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-2704
Mailing Address - Country:US
Mailing Address - Phone:530-872-4852
Mailing Address - Fax:
Practice Address - Street 1:865 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4646
Practice Address - Country:US
Practice Address - Phone:530-538-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-F0602090827101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)