Individual
JAQULIN FOWLER HAGEDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
2830 CORUNNA RD, FLINT, MI 48503-3254
(810) 235-6812
Mailing address
2830 CORUNNA RD, FLINT, MI 48503-3254
(810) 235-6812
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401016327
MI
101YP2500X
Professional Counselor
Primary
6401018092
MI
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
10/17/2014
Last updated
02/12/2020
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