Provider Demographics
NPI:1346847753
Name:GOGAN, CORNELIA (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:
Last Name:GOGAN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4226
Mailing Address - Country:US
Mailing Address - Phone:910-423-0128
Mailing Address - Fax:
Practice Address - Street 1:2106 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4226
Practice Address - Country:US
Practice Address - Phone:910-423-0128
Practice Address - Fax:910-423-0169
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP015324OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD