Provider Demographics
NPI:1588218093
Name:ANDERSON, ANGEL LYNN (CSAC, LPC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 DREW AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9161
Mailing Address - Country:US
Mailing Address - Phone:920-370-7676
Mailing Address - Fax:
Practice Address - Street 1:4340 ELM LAWN RD
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-9656
Practice Address - Country:US
Practice Address - Phone:920-370-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18937-130101YA0400X
WI11395-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)