Provider Demographics
NPI:1588678098
Name:POYTHRESS, ANGELA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:POYTHRESS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:POYTHRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-1478
Mailing Address - Country:US
Mailing Address - Phone:434-572-6916
Mailing Address - Fax:
Practice Address - Street 1:523 MADISON ST.
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917
Practice Address - Country:US
Practice Address - Phone:434-738-0154
Practice Address - Fax:434-572-4881
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO89322MOtherSENTARA
VA522666OtherVALUE OPTIONS
VA1700890761 - GR. NPIMedicaid
VA185980OtherANTHEM - HALIFAX
VA185982OtherANTHEM - MECK
VA185984OtherANTHEM - BRUNS