Provider Demographics
NPI:1992280846
Name:ALBERTSON, ANGELA NICOLE (MA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NICOLE
Last Name:ALBERTSON
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 1:3505 MALINA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6603
Mailing Address - Country:US
Mailing Address - Phone:330-388-6117
Mailing Address - Fax:
Practice Address - Street 1:1300 N HOLOPONO ST STE 108
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6946
Practice Address - Country:US
Practice Address - Phone:808-206-9371
Practice Address - Fax:855-270-7441
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health