Provider Demographics
NPI:1891152922
Name:HOGAN, HEATHER PATRICIA (CADC II)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:PATRICIA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W CLINTON AVE R, S, Y, D, P
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4201
Mailing Address - Country:US
Mailing Address - Phone:559-245-1129
Mailing Address - Fax:559-441-0303
Practice Address - Street 1:2550 W CLINTON AVE R, S, Y, D, P
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4201
Practice Address - Country:US
Practice Address - Phone:559-245-1129
Practice Address - Fax:559-441-0303
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CACI06481116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor