Provider Demographics
NPI:1083617351
Name:HAGGARD, CARLTON D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:D
Last Name:HAGGARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:STE 4
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6315
Mailing Address - Country:US
Mailing Address - Phone:770-435-2931
Mailing Address - Fax:770-435-2942
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:STE 4
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6315
Practice Address - Country:US
Practice Address - Phone:770-435-2931
Practice Address - Fax:770-435-2942
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0014561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA148495000OtherMAGELLAN
GA300033702AMedicaid
GA000697331CMedicaid
GA087343OtherVALUE OPTIONS
GAPVPB63279OtherAMERICAN PSYCH SYSTEMS
GA298302OtherCCN
GA196693OtherCOMPSYCH
GA087343OtherONE HEALTH PLAN
GA1015098OtherCIGNA BEHAVIORAL HEALTH
GA52426630-003OtherBLUE CROSS BLUE SHIELD
GA178135OtherMENTAL HEALTH NETWORK
GA843297OtherFIRST HEALTH
GA087343OtherGREAT WEST
GA085079OtherMANAGED HEALTH NETWORK
GA388692OtherAMERIHEALTH ADMINISTRATOR
GA62-04486OtherUNITED BEHAVIORAL HEALTH
GA388692OtherAMERIHEALTH ADMINISTRATOR
GA52426630-003OtherBLUE CROSS BLUE SHIELD