Provider Demographics
NPI:1093293425
Name:SAKELLARIOU, ANGELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:SAKELLARIOU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 S LOREN VON DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3819
Mailing Address - Country:US
Mailing Address - Phone:801-949-0879
Mailing Address - Fax:
Practice Address - Street 1:2304 CADET DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-5001
Practice Address - Country:US
Practice Address - Phone:801-949-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical