Provider Demographics
NPI:1194388371
Name:HOGUE, CHARLENE (LISW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1743
Mailing Address - Country:US
Mailing Address - Phone:914-772-8439
Mailing Address - Fax:
Practice Address - Street 1:167 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1743
Practice Address - Country:US
Practice Address - Phone:914-772-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22039771041C0700X
NY105029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical