Provider Demographics
NPI:1124419718
Name:MICHELS, ANGELA L (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:MICHELS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 S. 14TH ST
Mailing Address - Street 2:#302
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:904-557-8618
Mailing Address - Fax:888-463-2798
Practice Address - Street 1:1890 S. 14TH ST.
Practice Address - Street 2:#302
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-557-8618
Practice Address - Fax:888-463-2798
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health