Healthcare Provider Details

I. General information

NPI: 1679628648
Provider Name (Legal Business Name): KERRY L HOGAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3973B MARKET ST
WILMINGTON NC
28403-1403
US

IV. Provider business mailing address

3973B MARKET ST
WILMINGTON NC
28403-1403
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-0699
  • Fax: 910-763-0489
Mailing address:
  • Phone: 910-763-0699
  • Fax: 910-763-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2968
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2968
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2968
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2968
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2968
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: