Provider Demographics
NPI:1992187181
Name:HAGMAN, CASANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:
Last Name:HAGMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 DOUBLE CHURCHES RD UNIT 1282
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-7761
Mailing Address - Country:US
Mailing Address - Phone:706-888-0430
Mailing Address - Fax:
Practice Address - Street 1:185 MADDOX RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-4314
Practice Address - Country:US
Practice Address - Phone:706-888-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0079571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical