Provider Demographics
NPI:1285283861
Name:HAKIM, ANGEL B (LGPC)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:B
Last Name:HAKIM
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-0129
Mailing Address - Country:US
Mailing Address - Phone:912-920-0737
Mailing Address - Fax:
Practice Address - Street 1:1604 GUNPOWDER RIDGE RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-5430
Practice Address - Country:US
Practice Address - Phone:912-920-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9421101YM0800X
MDLCPC11283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCPC11283Medicaid