Provider Demographics
NPI:1497982821
Name:ANGULO, ELIZABETH MARIA (CDP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:ANGULO
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 NE 117TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4022
Mailing Address - Country:US
Mailing Address - Phone:360-566-9112
Mailing Address - Fax:360-566-9133
Practice Address - Street 1:2009 NE 117TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-4022
Practice Address - Country:US
Practice Address - Phone:360-566-9112
Practice Address - Fax:360-566-9133
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60018150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)