Provider Demographics
NPI:1104221076
Name:VOGEL, C MALINDA R (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:C MALINDA
Middle Name:R
Last Name:VOGEL
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 MAINE ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4272
Mailing Address - Country:US
Mailing Address - Phone:217-224-4080
Mailing Address - Fax:
Practice Address - Street 1:1891 MAINE ST
Practice Address - Street 2:SUITE #5
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4272
Practice Address - Country:US
Practice Address - Phone:217-224-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional