Provider Demographics
NPI:1255759973
Name:HOGAN, PEGGY JANE (LPC)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JANE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BENJAMIN H HILL DR SW STE 3
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8724
Mailing Address - Country:US
Mailing Address - Phone:229-392-9000
Mailing Address - Fax:229-233-6155
Practice Address - Street 1:288 BENJAMIN H HILL DR SW STE 3
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8724
Practice Address - Country:US
Practice Address - Phone:229-392-9000
Practice Address - Fax:229-233-6155
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149147AMedicaid