Provider Demographics
NPI:1083855423
Name:HAGAR, GINA M (PSYD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:HAGAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-0263
Mailing Address - Country:US
Mailing Address - Phone:925-451-3144
Mailing Address - Fax:828-665-7062
Practice Address - Street 1:611 OLD US HWY 70 E
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9488
Practice Address - Country:US
Practice Address - Phone:925-451-3144
Practice Address - Fax:828-665-7062
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001137Medicaid
NC2826013Medicare PIN
NCQ39595B309Medicare PIN