Provider Demographics
NPI:1093058596
Name:VASSELL, ANGELLA (MED CSC-AD)
Entity Type:Individual
Prefix:MISS
First Name:ANGELLA
Middle Name:
Last Name:VASSELL
Suffix:
Gender:F
Credentials:MED CSC-AD
Other - Prefix:MRS
Other - First Name:ANGELLA
Other - Middle Name:
Other - Last Name:VASSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3206 MCCURLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1449
Mailing Address - Country:US
Mailing Address - Phone:443-453-1161
Mailing Address - Fax:
Practice Address - Street 1:3206 MCCURLEY DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1449
Practice Address - Country:US
Practice Address - Phone:443-453-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)