Provider Demographics
NPI:1457147845
Name:HARKLESS, ANGEL MARIE
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARIE
Last Name:HARKLESS
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:ANGEL
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1856 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4178
Mailing Address - Country:US
Mailing Address - Phone:750-796-8835
Mailing Address - Fax:750-796-8835
Practice Address - Street 1:1856 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4178
Practice Address - Country:US
Practice Address - Phone:750-796-8835
Practice Address - Fax:750-796-8835
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health