Provider Demographics
NPI:1134502750
Name:LAM SLATE, ANGELIQUE JEANINE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:JEANINE
Last Name:LAM SLATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 STONE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6227
Mailing Address - Country:US
Mailing Address - Phone:276-233-3764
Mailing Address - Fax:276-236-8880
Practice Address - Street 1:487 STONE BROOK DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6227
Practice Address - Country:US
Practice Address - Phone:276-233-3764
Practice Address - Fax:276-236-8880
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601027524Medicaid