Provider Demographics
NPI:1386902930
Name:LAG, MICHAEL N (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:LAG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:LAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 N MARKET ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1752
Mailing Address - Country:US
Mailing Address - Phone:808-856-3149
Mailing Address - Fax:808-242-1469
Practice Address - Street 1:105 N MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1752
Practice Address - Country:US
Practice Address - Phone:808-856-3149
Practice Address - Fax:808-242-1469
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1678104100000X
171M00000X
HI41521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator