Provider Demographics
NPI:1982146379
Name:HOGGE, BENJAMIN (MA BCBA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HOGGE
Suffix:
Gender:M
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 BECONTREE LAKE DR
Mailing Address - Street 2:APT. 207
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4142
Mailing Address - Country:US
Mailing Address - Phone:301-751-9813
Mailing Address - Fax:
Practice Address - Street 1:1651 OLD MEADOW RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4311
Practice Address - Country:US
Practice Address - Phone:703-506-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000839103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst