Provider Demographics
NPI:1902283070
Name:HOAG, JAMES L JR (AAS, SUDP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:HOAG
Suffix:JR
Gender:M
Credentials:AAS, SUDP
Other - Prefix:
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Mailing Address - Street 1:5401 S 12TH ST APT 1304
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2614
Mailing Address - Country:US
Mailing Address - Phone:253-988-2191
Mailing Address - Fax:253-272-6666
Practice Address - Street 1:800 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-6995
Practice Address - Country:US
Practice Address - Phone:253-290-0431
Practice Address - Fax:253-517-3531
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60183363101YA0400X
WACP60534205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)