Provider Demographics
NPI:1417288952
Name:ULRICH, ANGELA DELIA (LFMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DELIA
Last Name:ULRICH
Suffix:
Gender:F
Credentials:LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1812
Mailing Address - Country:US
Mailing Address - Phone:619-281-3706
Mailing Address - Fax:
Practice Address - Street 1:510 DOYLE PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4570
Practice Address - Country:US
Practice Address - Phone:707-303-8360
Practice Address - Fax:707-303-8361
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist