Provider Demographics
NPI:1982174777
Name:TROGDON, MARK A
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TROGDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GALLIA ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4097
Mailing Address - Country:US
Mailing Address - Phone:130-496-2559
Mailing Address - Fax:
Practice Address - Street 1:725 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3936
Practice Address - Country:US
Practice Address - Phone:740-529-1191
Practice Address - Fax:740-529-0104
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.175121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)