Individual
INGRID MARIE HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MC, LPC, LISAC, NCC
Contact information
Practice address
1972 E BASELINE RD, SUITE B-102, TEMPE, AZ 85283-1532
(602) 618-2726
Mailing address
PO BOX 2501, CHANDLER, AZ 85244-2501
(602) 618-2726
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10492
AZ
101YP2500X
Professional Counselor
Primary
LPC-11062LISAC-10492
AZ
Other
Enumeration date
02/11/2006
Last updated
10/17/2019
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