Provider Demographics
NPI:1922444843
Name:HOGAN, MELISSA A (MSCP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1210 KAILEOLEA DR
Mailing Address - Street 2:2L2
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6241
Mailing Address - Country:US
Mailing Address - Phone:808-372-1952
Mailing Address - Fax:
Practice Address - Street 1:210 WARD AVE
Practice Address - Street 2:SUITE 219B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4008
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:808-585-0379
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health