Provider Demographics
NPI:1154560472
Name:ANGELICH, GEORGE DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAVID
Last Name:ANGELICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 S. DAKOTA AVE., NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017
Mailing Address - Country:US
Mailing Address - Phone:202-494-6722
Mailing Address - Fax:
Practice Address - Street 1:5840 MCARTHUR BLVD NW
Practice Address - Street 2:SUITE 2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2542
Practice Address - Country:US
Practice Address - Phone:202-494-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004036103TC0700X
DCPSY1000493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical