Provider Demographics
NPI:1003246224
Name:BOGAN, ANNETTE (CACLL)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BOGAN
Suffix:
Gender:F
Credentials:CACLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5556
Mailing Address - Country:US
Mailing Address - Phone:229-226-2234
Mailing Address - Fax:
Practice Address - Street 1:683 LINCOLN LN
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3383
Practice Address - Country:US
Practice Address - Phone:292-218-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health