Provider Demographics
NPI:1104536689
Name:KIEL, ANGELA WHITFIELD (LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:WHITFIELD
Last Name:KIEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 SOUTH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4357
Mailing Address - Country:US
Mailing Address - Phone:334-538-4559
Mailing Address - Fax:
Practice Address - Street 1:6701 SOUTH ST APT 210
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4357
Practice Address - Country:US
Practice Address - Phone:334-538-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional