Provider Demographics
NPI:1073016325
Name:STOVALL-CHRISTOPHER, ANGELETA LAVETTA
Entity type:Individual
Prefix:MRS
First Name:ANGELETA
Middle Name:LAVETTA
Last Name:STOVALL-CHRISTOPHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 DANCING BAY LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7125
Mailing Address - Country:US
Mailing Address - Phone:813-850-3989
Mailing Address - Fax:
Practice Address - Street 1:5032 DANCING BAY LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7125
Practice Address - Country:US
Practice Address - Phone:813-850-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician