Provider Demographics
NPI:1104127075
Name:CONGROVE, VICKI L (LISW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:CONGROVE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 STATE ROUTE 159
Mailing Address - Street 2:P.O. BOX 6179
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8620
Mailing Address - Country:US
Mailing Address - Phone:740-775-1260
Mailing Address - Fax:740-773-1264
Practice Address - Street 1:1300 E PAINT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1676
Practice Address - Country:US
Practice Address - Phone:740-335-6935
Practice Address - Fax:740-335-7423
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical