Provider Demographics
NPI:1134505761
Name:LONGTIN, ANGELA MARIE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:LONGTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13508 COUNTY 1
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-9421
Mailing Address - Country:US
Mailing Address - Phone:701-520-3655
Mailing Address - Fax:701-265-4628
Practice Address - Street 1:13508 COUNTY 1
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-9421
Practice Address - Country:US
Practice Address - Phone:701-520-3655
Practice Address - Fax:701-265-4628
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND469-12-1-01-187101YP2500X
469-12-1-01-187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional