Provider Demographics
NPI:1508614272
Name:PIERCE, ANGELINA MICHELLE (CADC, CRM II)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MICHELLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CADC, CRM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CENTENNIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7900
Mailing Address - Country:US
Mailing Address - Phone:541-342-6987
Mailing Address - Fax:541-342-7132
Practice Address - Street 1:1040 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3132
Practice Address - Country:US
Practice Address - Phone:541-342-6987
Practice Address - Fax:541-342-7138
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist