Doctor Name: | MS. VIRGINIA RAE O CONNELL |
NPI Number: | 1417013855 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ACADC, LBSW |
License Number: | 92124 |
Business Practice Address: | 36 S Frederick Ave Oelwein, IA - 506622305 |
Business Phone Number: | 3192835774 |
Business Fax Number: | 3192835775 |
Mailing Address: | 36 S Frederick Ave, P.o. Box 113 OELWEIN |
State: | IA |
Postal Code: | 506622305 |
Phone Number: | 3192835774 |
Fax Number: | 3192835775 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 92124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |