Provider Demographics
NPI:1710519418
Name:LIVINGSTON, ANGELLA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E REYNOLDS DR STE F2
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2809
Mailing Address - Country:US
Mailing Address - Phone:318-224-7203
Mailing Address - Fax:318-415-1004
Practice Address - Street 1:206 E REYNOLDS DR STE F2
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2809
Practice Address - Country:US
Practice Address - Phone:318-224-7223
Practice Address - Fax:318-445-1004
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5743101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health