Provider Demographics
NPI:1093047136
Name:ANGELA MCGOLDRICK, LPC, LLC
Entity Type:Organization
Organization Name:ANGELA MCGOLDRICK, LPC, LLC
Other - Org Name:LIFE IN BALANCE COUNSELING AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGOLDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-381-6215
Mailing Address - Street 1:400 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3139
Mailing Address - Country:US
Mailing Address - Phone:540-381-6215
Mailing Address - Fax:540-381-6216
Practice Address - Street 1:400 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3139
Practice Address - Country:US
Practice Address - Phone:540-381-6215
Practice Address - Fax:540-381-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679658587Medicaid
VA600651686Medicaid