Provider Demographics
NPI:1114523859
Name:ROYAL, ANGELICA (MA, LSWAIC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MA, LSWAIC
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2505 3RD AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2505 3RD AVE STE 325
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1458
Practice Address - Country:US
Practice Address - Phone:206-905-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC610401571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical