Provider Demographics
NPI:1710648498
Name:WARREN, ANGEL (LGPC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 COUNTRY RUN WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5907
Mailing Address - Country:US
Mailing Address - Phone:240-549-9592
Mailing Address - Fax:
Practice Address - Street 1:1815 COUNTRY RUN WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5907
Practice Address - Country:US
Practice Address - Phone:240-549-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty