Provider Demographics
NPI:1386114726
Name:DAMRON, ANGELA SUE (CDCA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:DAMRON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 STEFFENS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1226
Mailing Address - Country:US
Mailing Address - Phone:419-255-9585
Mailing Address - Fax:
Practice Address - Street 1:4747 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4307
Practice Address - Country:US
Practice Address - Phone:419-740-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
OHCDCA.174939101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other