Provider Demographics
NPI:1851922835
Name:STOVALL, ANGELA JEAN (LPCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:STOVALL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 FRONTIER WAY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8909
Mailing Address - Country:US
Mailing Address - Phone:701-232-2340
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:2600 DEMERS AVE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4100
Practice Address - Country:US
Practice Address - Phone:701-757-3045
Practice Address - Fax:701-751-3046
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17075101YM0800X
MNCC03928101YP2500X
ND1311-7-15-23-533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health