Healthcare Provider Details

I. General information

NPI: 1568667616
Provider Name (Legal Business Name): MELINDA RIGGER MOGOWSKI M.S., L.P.C.,L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E SOTHEL ST SOTHEL LIGHT OFFICES, SUITE 6
KILL DEVIL HILLS NC
27948-6961
US

IV. Provider business mailing address

PO BOX 3707
KILL DEVIL HILLS NC
27948-3707
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-3536
  • Fax: 252-441-3536
Mailing address:
  • Phone: 252-441-3536
  • Fax: 252-441-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: