Provider Demographics
NPI:1467909291
Name:GREGORY, ANGELA (CDCA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-4428
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:
Practice Address - Street 1:1832 ADAMS ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-4428
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CDCA.130282101Y00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health