Provider Demographics
NPI:1790058964
Name:CUSTER, ANGIE (LGPC)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CUSTER
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 1:201 N BURHANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4677
Mailing Address - Country:US
Mailing Address - Phone:301-791-2660
Mailing Address - Fax:301-791-5032
Practice Address - Street 1:201 N BURHANS BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4677
Practice Address - Country:US
Practice Address - Phone:301-791-2660
Practice Address - Fax:301-791-5032
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGPC3996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional