Provider Information for 1942394077
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Ms. ELAINA A BOGAN LCSW
Sex: Female
NPI: 1942394077
Last Updated: 2015-07-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1942394077 | ||||||||
| Enumeration Date | 2006-10-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4300 SAPPHIRE CT STE 110 GREENVILLE, NC 27834-9079 United States Phone: 252-830-7561 | Fax:252-413-0932 | ||||||||
| Primary Practice Address | 2901 N HERRITAGE ST KINSTON, NC 28501-1581 United States Phone: 252-233-2383 | Fax:252-523-3148 | ||||||||
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