Provider Demographics
NPI:1871651398
Name:TRIBE, ANGELINE RALEY (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELINE
Middle Name:RALEY
Last Name:TRIBE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANGELINE
Other - Middle Name:RALEY
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2694 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4904
Mailing Address - Country:US
Mailing Address - Phone:334-712-2720
Mailing Address - Fax:334-712-2727
Practice Address - Street 1:2694 S PARK AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4904
Practice Address - Country:US
Practice Address - Phone:334-712-2720
Practice Address - Fax:334-712-2727
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-36592OtherBLUE CROSS AND BLUE SHIEL