Provider Demographics
NPI:1609232396
Name:MENTINK, ANGELA (LAC, DIPL OM, ABT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MENTINK
Suffix:
Gender:F
Credentials:LAC, DIPL OM, ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SMITH DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-6704
Mailing Address - Country:US
Mailing Address - Phone:715-222-1515
Mailing Address - Fax:
Practice Address - Street 1:7740 AUGUSTA RD
Practice Address - Street 2:STE 3C
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6552
Practice Address - Country:US
Practice Address - Phone:864-320-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist