Provider Demographics
NPI:1083485551
Name:BOLENBAUGH, ANGELA M (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BOLENBAUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 HOCKING RUN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7960
Mailing Address - Country:US
Mailing Address - Phone:614-981-0463
Mailing Address - Fax:
Practice Address - Street 1:9085 SOUTHERN ST STE 220
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9360
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional