Provider Demographics
NPI:1518232248
Name:LANDRUM, ANGELA KAY (LLPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:LLPC
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 1254
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-1254
Mailing Address - Country:US
Mailing Address - Phone:517-898-2513
Mailing Address - Fax:
Practice Address - Street 1:416 ELMSHAVEN DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3513
Practice Address - Country:US
Practice Address - Phone:517-898-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional