Provider Demographics
NPI:1376373803
Name:VOGEL, NICHOLAS (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:VOGEL
Suffix:
Gender:M
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 LINCOLN AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2604
Mailing Address - Country:US
Mailing Address - Phone:631-605-0955
Mailing Address - Fax:
Practice Address - Street 1:2727 ELECTRIC RD STE 103
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3500
Practice Address - Country:US
Practice Address - Phone:540-354-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health