Healthcare Provider Details

I. General information

NPI: 1538483540
Provider Name (Legal Business Name): LISA K. KUGLAR L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA KNAPP KUGLAR L.C.S.W.

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

3405 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

V. Phone/Fax

Practice location:
  • Phone: 706-792-7085
  • Fax: 706-792-7093
Mailing address:
  • Phone: 706-792-7085
  • Fax: 706-792-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001736
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: