Provider Demographics
NPI:1912362310
Name:YOEBSTL, ANGELIA (CADC)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:YOEBSTL
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LOWER STONE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9140
Mailing Address - Country:US
Mailing Address - Phone:207-392-0665
Mailing Address - Fax:
Practice Address - Street 1:996 WILKINSON TRCE STE A4
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3408
Practice Address - Country:US
Practice Address - Phone:270-904-1072
Practice Address - Fax:270-904-1073
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)