Provider Demographics
NPI:1467099473
Name:HAAGA, KATHERINE BOLDING (MS, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BOLDING
Last Name:HAAGA
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 WELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5910
Mailing Address - Country:US
Mailing Address - Phone:901-497-9522
Mailing Address - Fax:
Practice Address - Street 1:6363 POPLAR AVE STE 404
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4831
Practice Address - Country:US
Practice Address - Phone:901-328-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional