Provider Demographics
NPI:1255707808
Name:BRIGGS, ANGELLA
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4304
Mailing Address - Country:US
Mailing Address - Phone:862-363-2253
Mailing Address - Fax:
Practice Address - Street 1:107 DR MARTIN LUTHER KING JR AVE STE 1
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4300
Practice Address - Country:US
Practice Address - Phone:800-539-4228
Practice Address - Fax:352-291-5588
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health