Healthcare Provider Details

I. General information

NPI: 1518598150
Provider Name (Legal Business Name): CATHERINE HAGWOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 CHARMANT PL STE 1
RIDGELAND MS
39157-4358
US

IV. Provider business mailing address

199 CHARMANT PL STE 1
RIDGELAND MS
39157-4358
US

V. Phone/Fax

Practice location:
  • Phone: 601-850-7047
  • Fax:
Mailing address:
  • Phone: 601-850-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2560
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: