Provider Demographics
NPI:1205262318
Name:PELLEGRIN, ANGELA PITRE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:PITRE
Last Name:PELLEGRIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PITRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:305 BARRILLEAUX ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:LA
Mailing Address - Zip Code:70374-2730
Mailing Address - Country:US
Mailing Address - Phone:985-688-7730
Mailing Address - Fax:
Practice Address - Street 1:305 BARRILLEAUX ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-2730
Practice Address - Country:US
Practice Address - Phone:985-688-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional