Provider Demographics
NPI:1902974611
Name:HOOKER, OLLIE DENNIS (LCAS)
Entity Type:Individual
Prefix:MR
First Name:OLLIE
Middle Name:DENNIS
Last Name:HOOKER
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4723 TANGLEWOOD OAKS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3159
Mailing Address - Country:US
Mailing Address - Phone:919-610-7892
Mailing Address - Fax:
Practice Address - Street 1:4723 TANGLEWOOD OAKS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3159
Practice Address - Country:US
Practice Address - Phone:919-610-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1017101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111894Medicaid
NC142CPOtherBLUE CROCC BLUE SHIELD