Provider Demographics
NPI:1093366908
Name:HAGE, MARTHA ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ELAINE
Last Name:HAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 OLD SPRING RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1319
Mailing Address - Country:US
Mailing Address - Phone:770-653-8548
Mailing Address - Fax:
Practice Address - Street 1:245 HAIRSTON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4137
Practice Address - Country:US
Practice Address - Phone:434-799-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0059471041C0700X
VA09040158531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical