Provider Demographics
NPI:1831544071
Name:HAUGEN, CHRIS (LCSW-C EDM)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:LCSW-C EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 SILVER HILL RD APT C
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5207
Mailing Address - Country:US
Mailing Address - Phone:240-640-0256
Mailing Address - Fax:
Practice Address - Street 1:413 MAIN ST
Practice Address - Street 2:# 1
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-7101
Practice Address - Country:US
Practice Address - Phone:240-640-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical