Healthcare Provider Details

I. General information

NPI: 1699393827
Provider Name (Legal Business Name): JENNIFER MICHELLE HOGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER HASKINS

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 CEDAR AVE STE 118
WILMINGTON NC
28403-4423
US

IV. Provider business mailing address

4514 BLUEBERRY RD
WILMINGTON NC
28405-8404
US

V. Phone/Fax

Practice location:
  • Phone: 910-586-1431
  • Fax: 910-240-9293
Mailing address:
  • Phone: 910-586-1431
  • Fax: 910-240-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: