Provider Demographics
NPI:1982647848
Name:HAGAN, DEBORAH (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7343
Mailing Address - Country:US
Mailing Address - Phone:864-406-6041
Mailing Address - Fax:864-406-6042
Practice Address - Street 1:248 ADLEY WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6511
Practice Address - Country:US
Practice Address - Phone:864-406-6041
Practice Address - Fax:864-406-6042
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051131041C0700X
SC86231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1601Medicaid