Provider Demographics
NPI:1194316471
Name:SHANKLE, ANGELA MARIE (MS, LADAC II)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:MS, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220A CABIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1410
Mailing Address - Country:US
Mailing Address - Phone:615-830-2764
Mailing Address - Fax:
Practice Address - Street 1:306 42ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3602
Practice Address - Country:US
Practice Address - Phone:615-830-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1245101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)