Provider Demographics
NPI:1588478945
Name:FLEENOR, ANGEL ELAINE (MA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ELAINE
Last Name:FLEENOR
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 1:1834 TWIN PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-7067
Mailing Address - Country:US
Mailing Address - Phone:573-529-1119
Mailing Address - Fax:
Practice Address - Street 1:1834 TWIN PINE BLVD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-7067
Practice Address - Country:US
Practice Address - Phone:573-529-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)