Provider Demographics
NPI:1710468806
Name:BOONE, ORGA MARIE
Entity Type:Individual
Prefix:
First Name:ORGA
Middle Name:MARIE
Last Name:BOONE
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 1:1333 CARRSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-3916
Mailing Address - Country:US
Mailing Address - Phone:757-304-9857
Mailing Address - Fax:757-304-2385
Practice Address - Street 1:1333 CARRSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-3916
Practice Address - Country:US
Practice Address - Phone:757-304-9857
Practice Address - Fax:757-304-2385
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102294101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0710102294Medicaid