Provider Demographics
NPI:1760925184
Name:ANGELO, NOELLE MICHELLE (SUDP)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:MICHELLE
Last Name:ANGELO
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S HILLHURST RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9063
Mailing Address - Country:US
Mailing Address - Phone:360-887-6060
Mailing Address - Fax:607-273-6383
Practice Address - Street 1:888 S HILLHURST RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9063
Practice Address - Country:US
Practice Address - Phone:360-887-6060
Practice Address - Fax:607-273-6383
Is Sole Proprietor?:No
Enumeration Date:2016-12-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60647981101YA0400X
WACP60893886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)