Provider Demographics
NPI:1639534340
Name:GIVENS, ANGELA (MSW, MPA, LAADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:MSW, MPA, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CERRITOS AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4758
Mailing Address - Country:US
Mailing Address - Phone:562-206-9847
Mailing Address - Fax:
Practice Address - Street 1:15161 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1432
Practice Address - Country:US
Practice Address - Phone:657-368-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI12440518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)