Provider Demographics
NPI:1588448385
Name:CARLTON, ANGELA EANAS ABRAHAM
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:EANAS ABRAHAM
Last Name:CARLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36890 GEMINA AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4205
Mailing Address - Country:US
Mailing Address - Phone:714-651-5520
Mailing Address - Fax:
Practice Address - Street 1:36890 GEMINA AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4205
Practice Address - Country:US
Practice Address - Phone:714-651-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty