Provider Demographics
NPI:1386831436
Name:HAMMOND, CARRIE LISA (MFT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LISA
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19725 SHERMAN WAY
Mailing Address - Street 2:#250
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3650
Mailing Address - Country:US
Mailing Address - Phone:818-802-0184
Mailing Address - Fax:
Practice Address - Street 1:19725 SHERMAN WAY
Practice Address - Street 2:#250
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3650
Practice Address - Country:US
Practice Address - Phone:818-802-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist