Provider Demographics
NPI:1871134494
Name:HAGGARD, AMANDA LEIGH (MSW, LCSW, LISW CP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 JAPONICA AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8848
Mailing Address - Country:US
Mailing Address - Phone:850-332-3087
Mailing Address - Fax:
Practice Address - Street 1:5435 JAPONICA AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8848
Practice Address - Country:US
Practice Address - Phone:850-332-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132861041C0700X
FLSW163361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical