Provider Demographics
NPI:1356689640
Name:MARS, ANGELA MARSHON (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARSHON
Last Name:MARS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5429
Mailing Address - Country:US
Mailing Address - Phone:601-581-7550
Mailing Address - Fax:601-581-7707
Practice Address - Street 1:4555 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5429
Practice Address - Country:US
Practice Address - Phone:601-581-7550
Practice Address - Fax:601-581-7707
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional