Provider Demographics
NPI:1619155504
Name:SOGC INC
Entity Type:Organization
Organization Name:SOGC INC
Other - Org Name:HOPE ENRICHMENT CNSLING CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF THERAPEUTIC SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POTTHAST
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMT
Authorized Official - Phone:563-381-4649
Mailing Address - Street 1:14542 61ST AVE.
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9592
Mailing Address - Country:US
Mailing Address - Phone:563-381-4649
Mailing Address - Fax:563-381-4649
Practice Address - Street 1:14542 61ST AVE.
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-9592
Practice Address - Country:US
Practice Address - Phone:563-381-4649
Practice Address - Fax:563-381-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health