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General NPI Number Information
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NPI Number | 1285800870
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Entity Type | Individual
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Provider Name | DEBORAH ANN BOGLE M.A., C.A.A.C.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 543 VANDERPOOL DR
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City | TROY
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State | MI
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Zip | 48083-5151
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Country | US
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Telephone | 248-244-2060
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Fax | 248-528-0308
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Provider Business Mailing Address
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Address Line | 543 VANDERPOOL DR
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City | TROY
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State | MI
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Zip | 48083-5151
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Country | US
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Telephone | 248-244-2060
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Fax | 248-528-0308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | C00640
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License Number State | MI
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