Provider Demographics
NPI:1871062190
Name:VOGT, MEGHAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W PARK SQ NE STE D
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2294
Mailing Address - Country:US
Mailing Address - Phone:646-932-0967
Mailing Address - Fax:
Practice Address - Street 1:13 W PARK SQ NE STE D
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2294
Practice Address - Country:US
Practice Address - Phone:404-494-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0065941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty