Provider Demographics
NPI:1194060434
Name:WAGGONER, ANGELA K (PHD, LPC-S , NCC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:PHD, LPC-S , NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 FAIRMONT PKWY # 361
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3722
Mailing Address - Country:US
Mailing Address - Phone:281-678-4622
Mailing Address - Fax:832-872-2033
Practice Address - Street 1:7433 HINSDALE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1113
Practice Address - Country:US
Practice Address - Phone:281-678-4622
Practice Address - Fax:832-872-2033
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65480101Y00000X, 101YP2500X
VA0701007809101YP2500X
TX1245389101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701007809OtherLICENSED PROFESSIONAL COUNSELOR - SUPERVISOR
TX65480OtherLICENSED PROFESSIONAL COUNSELOR - SUPERVISOR
LA8267OtherLICENSED PROFESSIONAL COUNSELOR - SUPERVISOR