Provider Demographics
NPI:1083069249
Name:MAC DULA, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MAC DULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 RING NECK ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1387
Mailing Address - Country:US
Mailing Address - Phone:707-853-7917
Mailing Address - Fax:
Practice Address - Street 1:328 RING NECK ST
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1387
Practice Address - Country:US
Practice Address - Phone:707-853-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2022-01-03
Deactivation Date:2018-11-20
Deactivation Code:
Reactivation Date:2020-06-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000OtherNAPA COUNTY MENTAL HEALTH