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Provider Information for 1841605607


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DESTINI HAGGEN


Sex: Female

NPI: 1841605607
Last Updated: 2019-02-20
Certification Date:

Details

NameValue
NPI1841605607
Enumeration Date2014-06-30
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 29007 MCDONALD ST
WESTLAND, MI 48186-5112
United States

Phone: 248-794-6604 | Fax:313-933-3974
 
Primary Practice Address 3901 CHRYSLER DR STE 1A
DETROIT, MI 48201-2167
United States

Phone: 313-993-3964 | Fax:313-933-3974
 
Secondary Practice Address(es)

1207 KNOLLWOOD AVE APT 1140
KALAMAZOO, MI 49006-6684
United States

Phone: 248-497-7837 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YA0400X - Counselor - Addiction (Substance Use Disorder)