Provider Demographics
NPI:1417013855
Name:O CONNELL, VIRGINIA RAE (ACADC, LBSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:RAE
Last Name:O CONNELL
Suffix:
Gender:F
Credentials:ACADC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S FREDERICK AVE
Mailing Address - Street 2:P.O. BOX 113
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2305
Mailing Address - Country:US
Mailing Address - Phone:319-283-5774
Mailing Address - Fax:319-283-5775
Practice Address - Street 1:36 S FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2305
Practice Address - Country:US
Practice Address - Phone:319-283-5774
Practice Address - Fax:319-283-5775
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA92124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04193OtherLBSW
IA92124OtherACADC