Provider Demographics
NPI:1265916860
Name:HOGAN, RICK R (CDP)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:R
Last Name:HOGAN
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:RONALD
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDP
Mailing Address - Street 1:12850 LALA COVE LN SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9664
Mailing Address - Country:US
Mailing Address - Phone:253-857-6201
Mailing Address - Fax:253-857-3993
Practice Address - Street 1:12850 LALA COVE LN SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9664
Practice Address - Country:US
Practice Address - Phone:253-857-6201
Practice Address - Fax:253-857-3993
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001154101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)