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General NPI Number Information
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NPI Number | 1114417722
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Entity Type | Organization
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Legal Business Name | AGAPE THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 160 CURTIS PKWY NE
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City | CALHOUN
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State | GA
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Zip | 30701-2062
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Country | US
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Telephone | 706-466-7076
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Fax | 706-466-7076
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Provider Business Mailing Address
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Address Line | 160 CURTIS PKWY NE
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City | CALHOUN
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State | GA
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Zip | 30701-2062
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Country | US
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Telephone | 706-466-7076
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Fax | 706-466-7076
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Authorized Official
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Title or Position | OWNER
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Name | MISS SHAWN EUDETTE HAGGARD
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Credential | LCSW
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Telephone | 678-986-7458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004585
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License Number State | GA
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