Provider Demographics
NPI:1821181736
Name:LILLIAN H OGLE LCSW PC
Entity Type:Organization
Organization Name:LILLIAN H OGLE LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-429-2114
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-0394
Mailing Address - Country:US
Mailing Address - Phone:276-429-2114
Mailing Address - Fax:276-429-2120
Practice Address - Street 1:468 E. MAIN ST., SUITE 100 JOHNSON CENTER
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-2140
Practice Address - Fax:276-628-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty