Provider Demographics
NPI:1336803410
Name:BERTOLINI, ANGELENA MARIE (LPC-R)
Entity Type:Individual
Prefix:
First Name:ANGELENA
Middle Name:MARIE
Last Name:BERTOLINI
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N MAPLELEAF AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1819
Mailing Address - Country:US
Mailing Address - Phone:180-492-9806
Mailing Address - Fax:
Practice Address - Street 1:16 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3723
Practice Address - Country:US
Practice Address - Phone:804-929-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional