Provider Demographics
NPI:1881651446
Name:PRINCE, ANGELA R (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-2709
Mailing Address - Country:US
Mailing Address - Phone:409-727-8997
Mailing Address - Fax:409-729-9747
Practice Address - Street 1:2721 NALL ST
Practice Address - Street 2:C
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5203
Practice Address - Country:US
Practice Address - Phone:409-727-8997
Practice Address - Fax:409-729-9747
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health