Provider Demographics
NPI:1124766258
Name:ANDERSON, ANGELA R (LCDCI)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5810
Mailing Address - Country:US
Mailing Address - Phone:806-452-8006
Mailing Address - Fax:806-452-8007
Practice Address - Street 1:4515 CORNELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5810
Practice Address - Country:US
Practice Address - Phone:806-452-8006
Practice Address - Fax:806-452-8007
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)