Provider Demographics
NPI:1417226358
Name:HADDEN, AMBER RENAE (RRW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENAE
Last Name:HADDEN
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68100 RAMON RD STE B10
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3388
Mailing Address - Country:US
Mailing Address - Phone:760-321-0870
Mailing Address - Fax:
Practice Address - Street 1:68100 RAMON RD STE B10
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3388
Practice Address - Country:US
Practice Address - Phone:760-321-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
REGISTERED RECOVERY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)