Provider Demographics
NPI:1619342466
Name:HAGGART, HELEN (AKA NICKIE) S (LCSW)
Entity Type:Individual
Prefix:
First Name:HELEN (AKA NICKIE)
Middle Name:S
Last Name:HAGGART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NICKIE
Other - Middle Name:S
Other - Last Name:HAGGART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3949 EVANS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9335
Mailing Address - Country:US
Mailing Address - Phone:239-470-3992
Mailing Address - Fax:
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9335
Practice Address - Country:US
Practice Address - Phone:239-470-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW23541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical