Provider Demographics
NPI:1780207126
Name:AOG, LLC
Entity Type:Organization
Organization Name:AOG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-500-4932
Mailing Address - Street 1:106 UNION FLATS BLVD APT 1A
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7242
Mailing Address - Country:US
Mailing Address - Phone:317-500-4932
Mailing Address - Fax:800-685-6587
Practice Address - Street 1:106 UNION FLATS BLVD APT 1A
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7242
Practice Address - Country:US
Practice Address - Phone:317-500-4932
Practice Address - Fax:800-685-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty