Provider Demographics
NPI:1265753230
Name:RITCHIE, FANTA TANAYA (MA)
Entity type:Individual
Prefix:MRS
First Name:FANTA
Middle Name:TANAYA
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:FANTA
Other - Middle Name:TANAYA
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43520 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4089
Mailing Address - Country:US
Mailing Address - Phone:661-266-4783
Mailing Address - Fax:661-266-1210
Practice Address - Street 1:43520 DIVISION ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4089
Practice Address - Country:US
Practice Address - Phone:661-266-4783
Practice Address - Fax:661-266-1210
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL