Provider Demographics
NPI:1740154830
Name:HOGAN, STEPHANIE BEATRIZ
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BEATRIZ
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BEATRIZ
Other - Last Name:SANABRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6112 LARSTAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1201
Mailing Address - Country:US
Mailing Address - Phone:571-400-1580
Mailing Address - Fax:
Practice Address - Street 1:8134 OLD KEENE MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1849
Practice Address - Country:US
Practice Address - Phone:571-400-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701015435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional