Provider Demographics
NPI:1548764582
Name:CABRERA, ANGELO LUIS (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:LUIS
Last Name:CABRERA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 NEWBYS WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7500
Mailing Address - Country:US
Mailing Address - Phone:804-836-7273
Mailing Address - Fax:
Practice Address - Street 1:7825 MIDLOTHIAN TPKE STE 203
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5247
Practice Address - Country:US
Practice Address - Phone:229-412-8125
Practice Address - Fax:804-621-2292
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007627101Y00000X, 101YP2500X
VAXXXXXXXXXXX101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578994687Medicaid
VA601141216Medicaid