Provider Demographics
NPI:1649487489
Name:HAGGARD, STEPHEN T (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:HAGGARD
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 1:330 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-240-9867
Mailing Address - Fax:313-240-9869
Practice Address - Street 1:330 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 900
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-240-9867
Practice Address - Fax:313-240-9869
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010603221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical