Provider Demographics
NPI:1952627168
Name:HOGAN, CARMALITA DENISE
Entity Type:Individual
Prefix:
First Name:CARMALITA
Middle Name:DENISE
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:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-0962
Mailing Address - Country:US
Mailing Address - Phone:903-917-3202
Mailing Address - Fax:
Practice Address - Street 1:104 N STEWART ST
Practice Address - Street 2:APT #F
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-1226
Practice Address - Country:US
Practice Address - Phone:903-917-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management