Provider Demographics
NPI:1285934216
Name:HAGAN, ANNA B (MED, EDS)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:B
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:B
Other - Last Name:THURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4550 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2939
Mailing Address - Country:US
Mailing Address - Phone:423-218-2275
Mailing Address - Fax:423-247-1117
Practice Address - Street 1:441 CLAY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3693
Practice Address - Country:US
Practice Address - Phone:423-218-2275
Practice Address - Fax:423-247-1117
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9820101YM0800X
TNLPC0000002588101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist