Provider Demographics
NPI:1710540729
Name:HAGMAN, JAMES ALLAN (MED, LCADC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLAN
Last Name:HAGMAN
Suffix:
Gender:M
Credentials:MED, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOFFMAN DR STE L
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3390
Mailing Address - Country:US
Mailing Address - Phone:270-826-5216
Mailing Address - Fax:270-826-2034
Practice Address - Street 1:401 HOFFMAN DR STE L
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3390
Practice Address - Country:US
Practice Address - Phone:270-826-5216
Practice Address - Fax:270-826-2034
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166634101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)