Provider Demographics
NPI:1790475663
Name:PRINCE, ANGELINA JOVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:JOVAN
Last Name:PRINCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8168 CROWN BAY MARINA STE 505
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-5866
Mailing Address - Country:US
Mailing Address - Phone:805-813-2414
Mailing Address - Fax:
Practice Address - Street 1:9151 ESTATE THOMAS STE 204
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2716
Practice Address - Country:US
Practice Address - Phone:340-774-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI23-052-PSY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical