Provider Demographics
NPI:1336816164
Name:SHERIDAN, ANGELA (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12836 LOMAS BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6200
Mailing Address - Country:US
Mailing Address - Phone:505-595-7149
Mailing Address - Fax:
Practice Address - Street 1:12836 LOMAS BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6200
Practice Address - Country:US
Practice Address - Phone:505-595-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0221441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health