Provider Demographics
NPI:1225036221
Name:HAGEN, SHARON LOUISE (MA,LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SISTER
Mailing Address - Street 1:27600 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4204
Mailing Address - Country:US
Mailing Address - Phone:248-851-7144
Mailing Address - Fax:248-626-5283
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:DEPT OF BEHAVORIAL SERVICES
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3306
Practice Address - Fax:248-849-5378
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178002051OtherLICENSED PROF. COUNSELOR
MI6401008255OtherBOARD OF COUNSELING