Provider Demographics
NPI:1457065054
Name:BRUMFIELD, ANGELA ANN (SUDP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ANN
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:BRUMFIELD-LEAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDP
Mailing Address - Street 1:511 W HERON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6022
Mailing Address - Country:US
Mailing Address - Phone:564-544-1943
Mailing Address - Fax:564-544-1928
Practice Address - Street 1:511 W HERON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6022
Practice Address - Country:US
Practice Address - Phone:564-544-1943
Practice Address - Fax:564-544-1928
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)