Provider Demographics
NPI:1598051583
Name:DE ANDA, ANGELICA (LMHC, CMHS)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:DE ANDA
Suffix:
Gender:F
Credentials:LMHC, CMHS
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 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:12835 BEL RED RD
Practice Address - Street 2:BLDG 100, STE 145
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2631
Practice Address - Country:US
Practice Address - Phone:425-460-7114
Practice Address - Fax:425-460-7115
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60190247101Y00000X
WALH 60510418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor