Provider Demographics
NPI:1033789722
Name:OGLECLARK, ANGELA (MS, LPC, CRC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OGLECLARK
Suffix:
Gender:F
Credentials:MS, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N THREE NOTCH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2021
Mailing Address - Country:US
Mailing Address - Phone:334-372-0346
Mailing Address - Fax:256-701-6926
Practice Address - Street 1:315 N THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2021
Practice Address - Country:US
Practice Address - Phone:334-372-0346
Practice Address - Fax:256-701-6926
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00117998225C00000X
AL2482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2482OtherSTATE LPC LICENSE
AL00117998OtherSTATE CRC LICENSE