Provider Demographics
NPI:1952508871
Name:ULLERY, ANGELA RAE (LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:ULLERY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BIG TREE RD APT 708
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8646
Mailing Address - Country:US
Mailing Address - Phone:386-847-1509
Mailing Address - Fax:
Practice Address - Street 1:1601 BIG TREE RD APT 708
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8646
Practice Address - Country:US
Practice Address - Phone:386-847-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YM0800XMedicaid