Provider Demographics
NPI:1558906735
Name:DEBOARD, ANGELA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:DEBOARD
Suffix:
Gender:F
Credentials:MA
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 4504
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0010
Mailing Address - Country:US
Mailing Address - Phone:804-608-9389
Mailing Address - Fax:804-763-3453
Practice Address - Street 1:9505 HULL STREET RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1475
Practice Address - Country:US
Practice Address - Phone:804-608-9597
Practice Address - Fax:804-763-3453
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health