Provider Demographics
NPI:1316180268
Name:RYAN-WILLIAMS, ANGELA D (MA, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:RYAN-WILLIAMS
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 PEAK RD
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-9602
Mailing Address - Country:US
Mailing Address - Phone:802-274-9059
Mailing Address - Fax:
Practice Address - Street 1:1129 MAIN ST
Practice Address - Street 2:C/O PENNY KIMBALL
Practice Address - City:ST. JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819
Practice Address - Country:US
Practice Address - Phone:802-274-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000664101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor