Provider Demographics
NPI:1518358621
Name:HOGAN, CHRISTINE ANGELA
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANGELA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 PEACHTREE CORNERS CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2571
Mailing Address - Country:US
Mailing Address - Phone:770-656-2006
Mailing Address - Fax:
Practice Address - Street 1:4725 PEACHTREE CORNERS CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2571
Practice Address - Country:US
Practice Address - Phone:770-656-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist