Provider Demographics
NPI:1649586025
Name:WOGAMON, LYNN SNIPES (LPES)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:SNIPES
Last Name:WOGAMON
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 HYDE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-5372
Mailing Address - Country:US
Mailing Address - Phone:843-532-4923
Mailing Address - Fax:843-962-5508
Practice Address - Street 1:1400 OLD TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5210
Practice Address - Country:US
Practice Address - Phone:843-532-4923
Practice Address - Fax:843-962-5508
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4583103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool