Healthcare Provider Details

I. General information

NPI: 1124336987
Provider Name (Legal Business Name): SONYA RENEE OGLESBY LPC, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 CANDLELIGHT DR
WINSTON SALEM NC
27107-6808
US

IV. Provider business mailing address

4854 CANDLELIGHT DR
WINSTON SALEM NC
27107-6808
US

V. Phone/Fax

Practice location:
  • Phone: 336-788-1817
  • Fax:
Mailing address:
  • Phone: 336-788-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8040
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3028-A
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number8040
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8040
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8040
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: