Provider Demographics
NPI:1760258859
Name:STIVERS, ANGELICA (LPCA)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:STIVERS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 CORTNER RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47141-9726
Mailing Address - Country:US
Mailing Address - Phone:502-541-5205
Mailing Address - Fax:
Practice Address - Street 1:8149 NEW LA GRANGE RD STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4689
Practice Address - Country:US
Practice Address - Phone:502-915-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY289022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional