Healthcare Provider Details

I. General information

NPI: 1770650442
Provider Name (Legal Business Name): CANDICE R HOGDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 N UNIVERSITY CHRISTUS LIGHT COUNSELING STE 109
PEORIA IL
61614-4763
US

IV. Provider business mailing address

5016 N UNIVERSITY CHRISTUS LIGHT COUNSELING STE 109
PEORIA IL
61614-4763
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-1220
  • Fax: 309-692-1222
Mailing address:
  • Phone: 309-692-1220
  • Fax: 309-692-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2243-123
License Number StateWI

VIII. Authorized Official

Name: MS. CANDICE RAE HOGDEN
Title or Position: DIRECTOR COUNSELOR
Credential: MS LCPC LCSW
Phone: 309-692-1220