Provider Demographics
NPI:1548077639
Name:HADEN, ALISSA (RADT, CHW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:HADEN
Suffix:
Gender:F
Credentials:RADT, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W GRAHAM AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3665
Mailing Address - Country:US
Mailing Address - Phone:888-638-8457
Mailing Address - Fax:
Practice Address - Street 1:506 W GRAHAM AVE STE 106
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3665
Practice Address - Country:US
Practice Address - Phone:888-638-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1587741124101YA0400X
CA101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health