Provider Demographics
NPI:1407285208
Name:PAYNE, ANGELIQUE
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 GODFREY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3820
Mailing Address - Country:US
Mailing Address - Phone:757-681-6804
Mailing Address - Fax:
Practice Address - Street 1:110 MAYCOX AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3433
Practice Address - Country:US
Practice Address - Phone:757-769-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health