Provider Demographics
NPI:1629218516
Name:MABE, ANGIE SUE (MA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:SUE
Last Name:MABE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 GRAND RUE DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2401
Mailing Address - Country:US
Mailing Address - Phone:407-285-6284
Mailing Address - Fax:
Practice Address - Street 1:320 CROWN OAKS CENTRE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6149
Practice Address - Country:US
Practice Address - Phone:407-376-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 5740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health