Provider Demographics
NPI:1922835040
Name:HADLOCK, ANNA MERCEDES
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MERCEDES
Last Name:HADLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:MERCEDES
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:3370 GLENDALE BLVD P.O. BOX 924
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039
Mailing Address - Country:US
Mailing Address - Phone:805-390-9126
Mailing Address - Fax:
Practice Address - Street 1:25000 AVENUE STANFORD STE 167
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4596
Practice Address - Country:US
Practice Address - Phone:818-600-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist