Healthcare Provider Details

I. General information

NPI: 1033789722
Provider Name (Legal Business Name): ANGELA OGLECLARK MS, LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N THREE NOTCH ST
TROY AL
36081-2021
US

IV. Provider business mailing address

315 N THREE NOTCH ST
TROY AL
36081-2021
US

V. Phone/Fax

Practice location:
  • Phone: 334-372-0346
  • Fax: 256-701-6926
Mailing address:
  • Phone: 334-372-0346
  • Fax: 256-701-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2482
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00117998
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: