=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952304644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILLIAN H OGLE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 468 E MAIN ST. SUIET 100 JOHNSON CENTER
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-628-2140
-----------------------------------------------------
Fax | 276-628-2140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 394
-----------------------------------------------------
City | GLADE SPRING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24340-0394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-429-2114
-----------------------------------------------------
Fax | 276-429-2120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904001976
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------