MEDICARE: CHARISSA BOGLE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	9891	TN
2	1041C0700X	Clinical Social Worker	8177	TN

General Provider Information

NPI Number	:	1033529052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA BOGLE LCSW

Provider Business Mailing Address
First Line	:	301 CAMBRIDGESHIRE CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4683
Country	:	US
Telephone Number	:	931-249-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 W SPRINGBROOK DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-1758
Country	:	US
Telephone Number	:	423-926-1171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	03/18/2024

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Directions to “ CHARISSA BOGLE LCSW” Practice Location

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