Provider Demographics
NPI:1497975098
Name:PRINCE, ANGIE B (MED, SR LPE)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:B
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MED, SR LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SUBURBAN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5552
Mailing Address - Country:US
Mailing Address - Phone:865-531-8728
Mailing Address - Fax:865-531-8787
Practice Address - Street 1:204 SUBURBAN RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5552
Practice Address - Country:US
Practice Address - Phone:865-531-8728
Practice Address - Fax:865-531-8787
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000000761103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling