Provider Demographics
NPI:1417665720
Name:BURTON, ANGELINA (MS, LPC-MHSP-T)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:MS, LPC-MHSP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 VICKERY LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1619
Mailing Address - Country:US
Mailing Address - Phone:901-308-6679
Mailing Address - Fax:
Practice Address - Street 1:1148 VICKERY LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1619
Practice Address - Country:US
Practice Address - Phone:901-308-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health