Provider Demographics
NPI:1396258208
Name:PEREZ, ANGELE
Entity type:Individual
Prefix:
First Name:ANGELE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELE
Other - Middle Name:
Other - Last Name:CRIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDCIII
Mailing Address - Street 1:809 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-1541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 BLOSSOM CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9317
Practice Address - Country:US
Practice Address - Phone:567-560-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161946101YA0400X
OHLCDCIII.162162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)