Doctor Name: | SAMUEL TERRANCE HARGROVE |
NPI Number: | 1043497522 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 408 Tennessee St Vallejo, CA - 945904453 |
Business Phone Number: | 7075542397 |
Business Fax Number: | |
Mailing Address: | 116 E K St, BENICIA |
State: | CA |
Postal Code: | 945103243 |
Phone Number: | 7077044638 |
Fax Number: | |
NPI Enumeration Date: | 01/27/2008 |
NPI Last Update Date: | 01/27/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |