Provider Demographics
NPI:1770691800
Name:BOGDAN, MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:102 HERITAGE WAY NE STE 302
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4544
Mailing Address - Country:US
Mailing Address - Phone:703-737-8529
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR SE STE LEESBURG
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4437
Practice Address - Country:US
Practice Address - Phone:703-554-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker