Provider Demographics
NPI:1285106781
Name:HAGA, PAMELA KENNEDY (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KENNEDY
Last Name:HAGA
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 ARLINGTON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8159
Mailing Address - Country:US
Mailing Address - Phone:615-944-5881
Mailing Address - Fax:
Practice Address - Street 1:9025 OVERLOOK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2710
Practice Address - Country:US
Practice Address - Phone:615-944-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional