Provider Demographics
NPI:1770650442
Name:CANDICE R HOGDEN
Entity Type:Organization
Organization Name:CANDICE R HOGDEN
Other - Org Name:CHRISTUS LIGHT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HOGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCPC LCSW
Authorized Official - Phone:309-692-1220
Mailing Address - Street 1:5016 N UNIVERSITY
Mailing Address - Street 2:CHRISTUS LIGHT COUNSELING STE 109
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4763
Mailing Address - Country:US
Mailing Address - Phone:309-692-1220
Mailing Address - Fax:309-692-1222
Practice Address - Street 1:5016 N UNIVERSITY
Practice Address - Street 2:CHRISTUS LIGHT COUNSELING STE 109
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-692-1220
Practice Address - Fax:309-692-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2243-123104100000X
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103515OtherHEALTH ALLIANCE
IL236610OtherVALUE OPTIONS
IL357929OtherMHN
WI39281200Medicaid
IL469922OtherHEALTHLINK
IL7230084OtherAETNA
IL07232101OtherBCBS