Provider Demographics
NPI:1114795341
Name:HAGUE, RICHARD DAVID
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:HAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 CHARLES TOWN RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-2669
Mailing Address - Country:US
Mailing Address - Phone:301-676-4060
Mailing Address - Fax:
Practice Address - Street 1:3094 CHARLES TOWN RD
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-2669
Practice Address - Country:US
Practice Address - Phone:304-901-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral