Provider Demographics
NPI:1558123448
Name:BOGAN, CARLTON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:BOGAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 LAUREL OAK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3509
Mailing Address - Country:US
Mailing Address - Phone:856-809-0433
Mailing Address - Fax:856-809-0554
Practice Address - Street 1:1016 LAUREL OAK RD STE 4
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3509
Practice Address - Country:US
Practice Address - Phone:856-809-0433
Practice Address - Fax:856-809-0554
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01002100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional