Provider Demographics
NPI:1710558812
Name:AGAPE, ANGELITA ROSA
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:ROSA
Last Name:AGAPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 FAIRWAY OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1647
Mailing Address - Country:US
Mailing Address - Phone:210-385-3833
Mailing Address - Fax:
Practice Address - Street 1:14110 FAIRWAY OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1647
Practice Address - Country:US
Practice Address - Phone:210-706-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional