Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2482 | AL |
N | 225C00000X | Rehabilitation Counselor | 00117998 | AL |
NPI | 1033789722 |
---|---|
Provider Name | Angela Ogleclark |
First Address | Troy, AL 36081-2021 |
Second Address | Troy, AL 36081-2021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00117998 | STATE CRC LICENSE (01) | AL |
2482 | STATE LPC LICENSE (01) | AL |