Provider Demographics
NPI:1003412107
Name:DUDOIT, ANGELA MICHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:DUDOIT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:DUDOIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:85-175 FARRINGTON HWY APT B116
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2175
Mailing Address - Country:US
Mailing Address - Phone:808-953-7205
Mailing Address - Fax:
Practice Address - Street 1:85-175 FARRINGTON HWY APT B116
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2175
Practice Address - Country:US
Practice Address - Phone:808-953-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-139664106S00000X
HI20-139664106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician