Provider Demographics
NPI:1952304644
Name:OGLE, LILLIAN H (LCSW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:H
Last Name:OGLE
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: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. SUIET 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
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA066728OtherBC BS
VA195523OtherVALUE OPTIONS
VA17162800OtherMAGELLAN
VA171628000OtherMAGELLAN MIS
VA85198OtherSENTARA
VA066728OtherANTHEM
VA008914435Medicaid
VA066728OtherBC BS