Provider Demographics
NPI:1386157345
Name:DEVINE, ANGELA M I (SUDP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:DEVINE
Suffix:I
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5810
Mailing Address - Country:US
Mailing Address - Phone:509-624-1244
Mailing Address - Fax:509-624-6240
Practice Address - Street 1:2308 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5810
Practice Address - Country:US
Practice Address - Phone:509-624-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60684760101YA0400X
WA60980687101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)