Provider Demographics
NPI:1619217932
Name:HAGUE, KRISTINA J (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:J
Last Name:HAGUE
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 EAST PARIS AVE SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2426
Mailing Address - Country:US
Mailing Address - Phone:616-929-0226
Mailing Address - Fax:
Practice Address - Street 1:2305 EAST PARIS AVE SE
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2426
Practice Address - Country:US
Practice Address - Phone:616-929-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional