Provider Demographics
NPI:1164998373
Name:PACK, ANGELA (CT, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PACK
Suffix:
Gender:F
Credentials:CT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 DEANSWAY DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7580
Mailing Address - Country:US
Mailing Address - Phone:740-251-7720
Mailing Address - Fax:
Practice Address - Street 1:428 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5344
Practice Address - Country:US
Practice Address - Phone:614-237-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801278-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty