Provider Demographics
NPI:1144581463
Name:RATHKAMP, ANGELA PARKS (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:PARKS
Last Name:RATHKAMP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:KRISTEN
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:12145 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-2204
Practice Address - Fax:410-651-0790
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD119591300Medicaid
MD211862Medicare Oscar/Certification