Provider Demographics
NPI:1326470147
Name:HAINSWORTH, ANGELA LYNN (MS)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LYNN
Last Name:HAINSWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 DEAN RD
Mailing Address - Street 2:SUITE #2402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4520
Mailing Address - Country:US
Mailing Address - Phone:904-674-8635
Mailing Address - Fax:188-897-2540
Practice Address - Street 1:1849 DEAN RD
Practice Address - Street 2:SUITE #2402
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4520
Practice Address - Country:US
Practice Address - Phone:904-674-8635
Practice Address - Fax:188-897-2540
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009868500Medicaid
FL1326470147OtherNPI FOR ANGELA HAINSWORTH
FL1578990784OtherNPI FOR NORTH FLORIDA CENTER FOR COUNSELING, LLC