Provider Demographics
NPI:1780603415
Name:HOOD, ANGELIQUE L (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:L
Last Name:HOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CORNELIA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1650 HOTEL CIR N
Mailing Address - Street 2:STE 203
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2818
Mailing Address - Country:US
Mailing Address - Phone:619-297-4499
Mailing Address - Fax:619-297-4479
Practice Address - Street 1:1650 HOTEL CIR N
Practice Address - Street 2:STE 203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2818
Practice Address - Country:US
Practice Address - Phone:619-297-4499
Practice Address - Fax:619-297-4479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS167501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5920530Medicaid
CA5920530Medicaid