Provider Demographics
NPI:1790014793
Name:HAIK, MAC (LCSW)
Entity Type:Individual
Prefix:
First Name:MAC
Middle Name:
Last Name:HAIK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5820
Mailing Address - Country:US
Mailing Address - Phone:225-925-1906
Mailing Address - Fax:225-925-1972
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5820
Practice Address - Country:US
Practice Address - Phone:225-925-1906
Practice Address - Fax:225-925-1972
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical