Provider Demographics
NPI:1235969585
Name:FIDDLERS GREEN COUNSELING
Entity type:Organization
Organization Name:FIDDLERS GREEN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAGERMANN
Authorized Official - Suffix:III
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-390-3025
Mailing Address - Street 1:163 PRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3653
Mailing Address - Country:US
Mailing Address - Phone:248-390-3025
Mailing Address - Fax:
Practice Address - Street 1:163 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3653
Practice Address - Country:US
Practice Address - Phone:248-390-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)