Healthcare Provider Details

I. General information

NPI: 1871904177
Provider Name (Legal Business Name): GAYE HAGAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 GORDON COMMERCIAL DR
LAGRANGE GA
30240-5735
US

IV. Provider business mailing address

764 WILD GINGER LN
AUBURN AL
36830-6050
US

V. Phone/Fax

Practice location:
  • Phone: 706-837-0045
  • Fax:
Mailing address:
  • Phone: 334-524-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC006942
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2431
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: