Provider Demographics
NPI:1265014773
Name:TAGABAN, ANGELICA A (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:A
Last Name:TAGABAN
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-542 MAHOE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3731
Mailing Address - Country:US
Mailing Address - Phone:808-729-4913
Mailing Address - Fax:
Practice Address - Street 1:98-030 HEKAHA ST STE 24
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4911
Practice Address - Country:US
Practice Address - Phone:808-729-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health