Provider Demographics
NPI:1881897320
Name:COOGAN, THOMAS GERARD JR (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GERARD
Last Name:COOGAN
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4909 WATERS EDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2462
Mailing Address - Country:US
Mailing Address - Phone:919-538-3458
Mailing Address - Fax:
Practice Address - Street 1:4909 WATERS EDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2462
Practice Address - Country:US
Practice Address - Phone:919-538-3458
Practice Address - Fax:888-325-6160
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional