Provider Demographics
NPI:1659921690
Name:D'ANGELO, TANYA (MS, CRC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 STERLING GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2882
Mailing Address - Country:US
Mailing Address - Phone:760-534-2149
Mailing Address - Fax:
Practice Address - Street 1:16959 BERNARDO CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2554
Practice Address - Country:US
Practice Address - Phone:619-281-6414
Practice Address - Fax:619-359-4326
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health