Provider Demographics
NPI:1073726303
Name:ENNIS-BENFORD, ANGELA MARIA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:ENNIS-BENFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-6984
Mailing Address - Country:US
Mailing Address - Phone:214-372-6361
Mailing Address - Fax:
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-371-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator