Provider Demographics
NPI:1336433754
Name:DRASKOVICH, ANGELICA MARIA (MFT-INTERN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:DRASKOVICH
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12242 TERRACE VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1122
Mailing Address - Country:US
Mailing Address - Phone:702-360-4356
Mailing Address - Fax:
Practice Address - Street 1:12242 TERRACE VERDE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-1122
Practice Address - Country:US
Practice Address - Phone:702-360-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist