1952304644 NPI number — LILLIAN H OGLE LCSW

Table of content: LILLIAN H OGLE LCSW (NPI 1952304644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952304644 NPI number — LILLIAN H OGLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGLE
Provider First Name:
LILLIAN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952304644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 394
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADE SPRING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24340-0394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-429-2114
Provider Business Mailing Address Fax Number:
276-429-2120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
468 E MAIN ST. SUIET 100 JOHNSON CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-628-2140
Provider Business Practice Location Address Fax Number:
276-628-2140
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904001976 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 066728 . This is a "BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 195523 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 17162800 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 171628000 . This is a "MAGELLAN MIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 85198 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 066728 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008914435 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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