Healthcare Provider Details

I. General information

NPI: 1902011695
Provider Name (Legal Business Name): KEVIN L OGLE D.MIN., AAPC FELLOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N JACKSON ST
ARLINGTON VA
22201-2238
US

IV. Provider business mailing address

309 BUXTON RD
FALLS CHURCH VA
22046-3619
US

V. Phone/Fax

Practice location:
  • Phone: 703-903-9696
  • Fax: 703-821-2505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: