Provider Demographics
NPI:1063179810
Name:LAPRISE, ANGELIQUE DANIELLE (SUDRC #12534)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:DANIELLE
Last Name:LAPRISE
Suffix:
Gender:F
Credentials:SUDRC #12534
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 PLEASANT VALLEY RD.
Mailing Address - Street 2:# 4
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-344-7633
Mailing Address - Fax:530-497-5202
Practice Address - Street 1:484 PLEASANT VALLEY RD.
Practice Address - Street 2:# 4
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-344-7633
Practice Address - Fax:530-497-5202
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12534101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)