=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972531002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. KATHERINE W FOGLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 08/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4942 NEESES HWY
-----------------------------------------------------
City | NEESES
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29107-9082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-603-4417
-----------------------------------------------------
Fax | 803-247-2879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4942 NEESES HWY
-----------------------------------------------------
City | NEESES
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29107-9082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-603-4417
-----------------------------------------------------
Fax | 803-247-2879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2333
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------