Provider Demographics
NPI:1568123396
Name:ANGULO, MAYERLIN (CBHT)
Entity Type:Individual
Prefix:
First Name:MAYERLIN
Middle Name:
Last Name:ANGULO
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 JIMMY CARTER BLVD STE 1700
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1269
Mailing Address - Country:US
Mailing Address - Phone:786-608-2876
Mailing Address - Fax:
Practice Address - Street 1:6825 JIMMY CARTER BLVD STE 1700
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1269
Practice Address - Country:US
Practice Address - Phone:786-608-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management