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General NPI Number Information
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NPI Number | 1205254760
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Entity Type | Individual
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Provider Name | KIMBERLEIGH HAGAR
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Gender | Female
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 16147 LANCASTER HWY STE 110
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City | CHARLOTTE
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State | NC
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Zip | 28277-4196
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Country | US
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Telephone | 847-447-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 8230 CARTER CREEK DR APT 303
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City | CHARLOTTE
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State | NC
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Zip | 28227-4723
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Country | US
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Telephone | 847-769-4167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 149018265
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150014590
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License Number State | IL
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