Provider Demographics
NPI:1528685294
Name:HAGEN, ANDREA (LMSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7173 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-9329
Mailing Address - Country:US
Mailing Address - Phone:231-730-4399
Mailing Address - Fax:
Practice Address - Street 1:259 HOOVER BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3790
Practice Address - Country:US
Practice Address - Phone:616-460-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010909841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical