Provider Demographics
NPI:1710056551
Name:SIMPSON, ANGELA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-0010
Mailing Address - Country:US
Mailing Address - Phone:804-343-5153
Mailing Address - Fax:804-716-9642
Practice Address - Street 1:1800 N. 22ND STEET
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-0010
Practice Address - Country:US
Practice Address - Phone:804-343-5153
Practice Address - Fax:804-716-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010134501Medicaid