Provider Demographics
NPI:1689905630
Name:PLANT, ANGELA R (LCDC III)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:PLANT
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9708
Mailing Address - Country:US
Mailing Address - Phone:419-483-3918
Mailing Address - Fax:419-484-1203
Practice Address - Street 1:5433 STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9708
Practice Address - Country:US
Practice Address - Phone:567-256-3450
Practice Address - Fax:567-256-3451
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)