Provider Demographics
NPI:1396058798
Name:MAXWELL, ANGELIA DANIELL (MA)
Entity type:Individual
Prefix:MS
First Name:ANGELIA
Middle Name:DANIELL
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 TIMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8664
Mailing Address - Country:US
Mailing Address - Phone:931-265-0518
Mailing Address - Fax:
Practice Address - Street 1:201 UFFELMAN DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2975
Practice Address - Country:US
Practice Address - Phone:931-920-7333
Practice Address - Fax:931-920-7332
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health