Provider Demographics
NPI:1710278858
Name:ANGEL MENTAL HEALTH COUNSELING, P.A.
Entity Type:Organization
Organization Name:ANGEL MENTAL HEALTH COUNSELING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDADIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-287-5487
Mailing Address - Street 1:650 S CENTRAL AVE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5900
Mailing Address - Country:US
Mailing Address - Phone:407-977-7943
Mailing Address - Fax:407-977-7944
Practice Address - Street 1:650 S CENTRAL AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5900
Practice Address - Country:US
Practice Address - Phone:407-977-7943
Practice Address - Fax:407-977-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7371305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization