Provider Demographics
NPI:1558814533
Name:HOGAN, CHRISTINE (MA LPC LCAS CCS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MA LPC LCAS CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 CHARLOTTE HWY STE 16
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8149
Mailing Address - Country:US
Mailing Address - Phone:803-620-5777
Mailing Address - Fax:
Practice Address - Street 1:4607 CHARLOTTE HWY STE 16
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8149
Practice Address - Country:US
Practice Address - Phone:803-620-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23012101YA0400X
NC12716101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional