Provider Demographics
NPI:1003971532
Name:HAGAN, LINDA BAILEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BAILEY
Last Name:HAGAN
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 1:1814 LAKEFIELD CT SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1776
Mailing Address - Country:US
Mailing Address - Phone:770-922-4770
Mailing Address - Fax:770-922-4993
Practice Address - Street 1:1814 LAKEFIELD CT SE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1776
Practice Address - Country:US
Practice Address - Phone:770-922-4770
Practice Address - Fax:770-922-4993
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0003211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical