Provider Demographics
NPI:1962562439
Name:HAWTHORNE, ANGELA HOLTONH (LMHC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:HOLTONH
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11513 SHORT AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3846
Mailing Address - Country:US
Mailing Address - Phone:727-433-3009
Mailing Address - Fax:727-517-7373
Practice Address - Street 1:2101 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1037
Practice Address - Country:US
Practice Address - Phone:727-433-3009
Practice Address - Fax:727-517-7373
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health