Provider Demographics
NPI:1518440486
Name:PETRY, ANGELA DAWN CHEATHAM (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN CHEATHAM
Last Name:PETRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 GUM FORK RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1420
Mailing Address - Country:US
Mailing Address - Phone:804-502-5622
Mailing Address - Fax:
Practice Address - Street 1:1909 HUGUENOT RD STE 301
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4314
Practice Address - Country:US
Practice Address - Phone:804-350-7952
Practice Address - Fax:866-330-1467
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health