Provider Demographics
NPI:1225635196
Name:ANGEL'S POND COUNSELING
Entity Type:Organization
Organization Name:ANGEL'S POND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:THARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-791-2474
Mailing Address - Street 1:300 HERON COVE DR
Mailing Address - Street 2:APT D214
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330
Mailing Address - Country:US
Mailing Address - Phone:334-477-4531
Mailing Address - Fax:
Practice Address - Street 1:208 SEARCY ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2739
Practice Address - Country:US
Practice Address - Phone:334-477-4531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty