Basic Information
| Provider Information | |||||||||
| NPI: | 1841605607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGGEN | ||||||||
| FirstName: | DESTINI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29007 MCDONALD ST | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481865112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487946604 | ||||||||
| FaxNumber: | 3139333974 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 CHRYSLER DR STE 1A | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139933964 | ||||||||
| FaxNumber: | 3139333974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.