Provider Demographics
NPI:1124680202
Name:DAMON, ANGELA JEAN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:DAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:ADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 FESLER ST STE G-1
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1959
Mailing Address - Country:US
Mailing Address - Phone:619-588-5361
Mailing Address - Fax:
Practice Address - Street 1:550 FESLER ST STE G-1
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1959
Practice Address - Country:US
Practice Address - Phone:619-588-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)