Provider Demographics
NPI:1932583614
Name:HOZIAN, THERESA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:HOZIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 HEALDSBURG AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3309
Mailing Address - Country:US
Mailing Address - Phone:415-994-0047
Mailing Address - Fax:
Practice Address - Street 1:7765 HEALDSBURG AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3309
Practice Address - Country:US
Practice Address - Phone:415-994-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94021621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical