Provider Demographics
NPI:1083799837
Name:DOYLE, ANGELIA JOAN (LCSW LICENSED CLINIC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:JOAN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12046
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308
Mailing Address - Country:US
Mailing Address - Phone:731-664-9146
Mailing Address - Fax:731-422-1000
Practice Address - Street 1:36 SANDSTONE CIRCLE
Practice Address - Street 2:SUITE F
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38308
Practice Address - Country:US
Practice Address - Phone:731-664-9146
Practice Address - Fax:731-422-1000
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical