Provider Demographics
NPI:1023555810
Name:PERISON, ANGELA (LCDC II)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PERISON
Suffix:
Gender:F
Credentials:LCDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1760
Mailing Address - Country:US
Mailing Address - Phone:614-981-4067
Mailing Address - Fax:
Practice Address - Street 1:510 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5571
Practice Address - Country:US
Practice Address - Phone:651-422-7969
Practice Address - Fax:614-227-0370
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121043101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)