Provider Demographics
NPI:1124336987
Name:OGLESBY, SONYA RENEE (LPC, LCAS-A)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:RENEE
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LPC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 CANDLELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6808
Mailing Address - Country:US
Mailing Address - Phone:336-788-1817
Mailing Address - Fax:
Practice Address - Street 1:4854 CANDLELIGHT DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6808
Practice Address - Country:US
Practice Address - Phone:336-788-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8040101Y00000X, 101YP1600X, 101YP2500X, 101YM0800X
NC3028-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115116Medicaid