Provider Demographics
NPI:1649093204
Name:HAGAN, ERICA LASHAWN (PLMFT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LASHAWN
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 CABANNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2410
Mailing Address - Country:US
Mailing Address - Phone:314-601-2737
Mailing Address - Fax:
Practice Address - Street 1:5415 PAGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3416
Practice Address - Country:US
Practice Address - Phone:314-601-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024040482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist