Provider Demographics
NPI:1588457170
Name:BAILEY-HOGAN, HEAVEN (LCSW)
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:
Last Name:BAILEY-HOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 APACHE CANYON RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-4126
Mailing Address - Country:US
Mailing Address - Phone:540-835-9401
Mailing Address - Fax:
Practice Address - Street 1:11720 MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7368
Practice Address - Country:US
Practice Address - Phone:540-735-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040179971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical