Provider Demographics
NPI:1346857075
Name:HAMMERCORD, NEESHA RAY (SUDRC)
Entity Type:Individual
Prefix:
First Name:NEESHA
Middle Name:RAY
Last Name:HAMMERCORD
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:NEESHA
Other - Middle Name:RAY
Other - Last Name:ACORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22425 SUNBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9741
Mailing Address - Country:US
Mailing Address - Phone:530-528-2342
Mailing Address - Fax:
Practice Address - Street 1:22425 SUNBRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-9741
Practice Address - Country:US
Practice Address - Phone:530-528-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC11097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)