Provider Demographics
NPI:1376104687
Name:OGILVIE, DIANE CAROL
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:OGILVIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 PRINCETON WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4479
Mailing Address - Country:US
Mailing Address - Phone:907-242-1105
Mailing Address - Fax:
Practice Address - Street 1:10200 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7807
Practice Address - Country:US
Practice Address - Phone:907-283-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)