Provider Demographics
NPI:1245642214
Name:HAENTJENS, ERIN (MA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HAENTJENS
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530077
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0077
Mailing Address - Country:US
Mailing Address - Phone:888-588-8995
Mailing Address - Fax:
Practice Address - Street 1:1439 STONEHEDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1052
Practice Address - Country:US
Practice Address - Phone:925-705-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115872106H00000X
CAB7432915390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program