Provider Demographics
NPI:1508007998
Name:SMITH-HOGAN, DONNA ALICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ALICIA
Last Name:SMITH-HOGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 VILLAGE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-3706
Mailing Address - Country:US
Mailing Address - Phone:704-962-2497
Mailing Address - Fax:
Practice Address - Street 1:8211 VILLAGE HARBOR DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-3706
Practice Address - Country:US
Practice Address - Phone:704-962-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3663103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001205Medicaid