Provider Demographics
NPI:1033289343
Name:FLORES, ANGELA C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:C
Last Name:FLORES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:GULLICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:343 WOOD LAKE DR SE
Mailing Address - Street 2:ZUMBRO VALLEY MENTAL HEALTH CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-289-2089
Mailing Address - Fax:507-535-5791
Practice Address - Street 1:343 WOOD LAKE DR SE
Practice Address - Street 2:ZUMBRO VALLEY MENTAL HEALTH CENTER
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904
Practice Address - Country:US
Practice Address - Phone:507-289-2089
Practice Address - Fax:507-535-5791
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical