Provider Demographics
NPI:1326269630
Name:HIAWATHA HARRIS, CORPORATION
Entity Type:Organization
Organization Name:HIAWATHA HARRIS, CORPORATION
Other - Org Name:PATHWAYS TO WELLNESS, MEDICATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:NEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-520-0005
Mailing Address - Street 1:5674 STONERIDGE DR STE 116
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8536
Mailing Address - Country:US
Mailing Address - Phone:925-520-0005
Mailing Address - Fax:925-520-0010
Practice Address - Street 1:4241 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2003
Practice Address - Country:US
Practice Address - Phone:562-988-1700
Practice Address - Fax:562-988-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22371101YM0800X, 103TC2200X, 103TF0000X, 103TM1800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty