Provider Demographics
NPI:1447572953
Name:SOLANO, ANGELLE T (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELLE
Middle Name:T
Last Name:SOLANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2666
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-2666
Mailing Address - Country:US
Mailing Address - Phone:361-575-8271
Mailing Address - Fax:361-575-6520
Practice Address - Street 1:120 DAVID WADE DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905
Practice Address - Country:US
Practice Address - Phone:361-575-8271
Practice Address - Fax:361-575-6520
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53107101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional