Provider Demographics
NPI:1013960897
Name:HASKINS, MARK G (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:HASKINS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2092 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1831
Mailing Address - Country:US
Mailing Address - Phone:734-457-2161
Mailing Address - Fax:734-457-4146
Practice Address - Street 1:2092 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1831
Practice Address - Country:US
Practice Address - Phone:734-457-2161
Practice Address - Fax:734-457-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00092401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6980Medicare PIN