Provider Demographics
NPI:1023464948
Name:ANGEVINE, DORA L (LPC)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:L
Last Name:ANGEVINE
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7036 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1938
Mailing Address - Country:US
Mailing Address - Phone:314-514-5107
Mailing Address - Fax:
Practice Address - Street 1:7036 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1938
Practice Address - Country:US
Practice Address - Phone:314-514-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002608101YP2500X
ORC4910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional