Provider Demographics
NPI:1609178193
Name:STEBBINS, ANGELA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:STEBBINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:HANCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4305 N LINCOLN AVE
Mailing Address - Street 2:STE M
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1807
Mailing Address - Country:US
Mailing Address - Phone:872-216-7743
Mailing Address - Fax:855-727-4855
Practice Address - Street 1:4305 N LINCOLN AVE
Practice Address - Street 2:STE M
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1807
Practice Address - Country:US
Practice Address - Phone:872-216-7743
Practice Address - Fax:855-727-4855
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3154-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist