Provider Demographics
NPI:1740557099
Name:BACH, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BACH
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 1:3600 MERIDALE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1145
Mailing Address - Country:US
Mailing Address - Phone:804-840-6176
Mailing Address - Fax:804-272-1571
Practice Address - Street 1:3111 NORTHSIDE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5441
Practice Address - Country:US
Practice Address - Phone:804-840-6176
Practice Address - Fax:804-272-1571
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional