Provider Demographics
NPI:1063582773
Name:D'ANGELO, VIRGINIA (LMFT)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7493 147TH ST W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4505
Mailing Address - Country:US
Mailing Address - Phone:952-432-0043
Mailing Address - Fax:952-432-0809
Practice Address - Street 1:7493 147TH ST W STE 107
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7570
Practice Address - Country:US
Practice Address - Phone:952-432-0043
Practice Address - Fax:952-432-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0768106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN307082400Medicaid