Provider Demographics
NPI:1407614928
Name:PAUL, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, SWC, ADDC
Mailing Address - Street 1:661 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6018
Mailing Address - Country:US
Mailing Address - Phone:970-640-6028
Mailing Address - Fax:
Practice Address - Street 1:661 TURNBERRY CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6018
Practice Address - Country:US
Practice Address - Phone:970-640-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002459101YA0400X
COSWC.00000011061041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)