Provider Demographics
NPI:1922191832
Name:BOGGS, DONNA ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ELAINE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 EUCLID AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3655
Mailing Address - Country:US
Mailing Address - Phone:276-669-5179
Mailing Address - Fax:276-466-8870
Practice Address - Street 1:2195 EUCLID AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3655
Practice Address - Country:US
Practice Address - Phone:276-669-5179
Practice Address - Fax:276-466-8870
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010276675Medicaid
VAMC12323Medicare PIN