Doctor Name: | MICHELLE HAGERTY |
NPI Number: | 1871996322 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RAS |
License Number: | H1209191403 |
Business Practice Address: | 16940 State Highway 14 Mojave, CA - 935011238 |
Business Phone Number: | 6618245020 |
Business Fax Number: | 6618245026 |
Mailing Address: | 16940 State Highway 14 Ste F, MOJAVE |
State: | CA |
Postal Code: | 935011238 |
Phone Number: | 6618245020 |
Fax Number: | 6618245026 |
NPI Enumeration Date: | 09/29/2014 |
NPI Last Update Date: | 10/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | H1209191403 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |