Provider Demographics
NPI:1891179909
Name:OGOE, LUKETHIA (PHD)
Entity Type:Individual
Prefix:
First Name:LUKETHIA
Middle Name:
Last Name:OGOE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10884 SOUTHSHORE CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6175
Mailing Address - Country:US
Mailing Address - Phone:678-522-5687
Mailing Address - Fax:
Practice Address - Street 1:10884 SOUTHSHORE CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6175
Practice Address - Country:US
Practice Address - Phone:678-522-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG0108101YA0400X
AL572508122010101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)