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General NPI Number Information
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NPI Number | 1396800819
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Entity Type | Organization
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Legal Business Name | COLLEEN L HAGAN LCSW INC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 29 SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 678-469-1409
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Fax | 770-858-1700
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Provider Business Mailing Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 29 SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 678-469-1409
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Fax | 770-858-1700
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. COLLEEN L HAGAN
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Credential | LCSW
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Telephone | 678-469-1409
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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 | CSW001379
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License Number State | GA
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