Healthcare Provider Details

I. General information

NPI: 1275211344
Provider Name (Legal Business Name): CAROLINE HOGEVEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE H160
ALBUQUERQUE NM
87104-2063
US

IV. Provider business mailing address

7216 TICONDEROGA RD NE
ALBUQUERQUE NM
87109-5081
US

V. Phone/Fax

Practice location:
  • Phone: 317-331-0028
  • Fax:
Mailing address:
  • Phone: 317-331-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: