Provider Demographics
NPI:1316577331
Name:HAYGOOD, GRACIA (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:HAYGOOD
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 1:1815 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5979
Mailing Address - Country:US
Mailing Address - Phone:863-709-9392
Mailing Address - Fax:
Practice Address - Street 1:5421 US HWY 98 S
Practice Address - Street 2:
Practice Address - City:HIGHLAND CITY
Practice Address - State:FL
Practice Address - Zip Code:33846
Practice Address - Country:US
Practice Address - Phone:863-701-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW160381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical