Provider Demographics
NPI:1467933085
Name:ROSEN-HANSON, FELECYTIE SARAH
Entity Type:Individual
Prefix:
First Name:FELECYTIE
Middle Name:SARAH
Last Name:ROSEN-HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CRESCENT DR STE A
Mailing Address - Street 2:#726
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5508
Mailing Address - Country:US
Mailing Address - Phone:925-325-4239
Mailing Address - Fax:
Practice Address - Street 1:3496 BUSKIRK AVE STE 103
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4368
Practice Address - Country:US
Practice Address - Phone:925-325-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist