Provider Demographics
NPI:1508650300
Name:WARE, ANGELA CHRISTINA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINA
Last Name:WARE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 103RD ST APT 3101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8814
Mailing Address - Country:US
Mailing Address - Phone:803-664-7518
Mailing Address - Fax:
Practice Address - Street 1:10350 103RD ST APT 3101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8814
Practice Address - Country:US
Practice Address - Phone:803-664-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4316103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty