Provider Demographics
NPI:1912155045
Name:HOGG, RUSSELL WILLIAM (MED,CAC,LPC,CCDP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:HOGG
Suffix:
Gender:M
Credentials:MED,CAC,LPC,CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PINEWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-626-6811
Mailing Address - Fax:
Practice Address - Street 1:3030 CHESTNUT ST.
Practice Address - Street 2:LEBANON TREATMENT CENTER
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-273-8000
Practice Address - Fax:717-273-8244
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)