Provider Demographics
NPI:1720617673
Name:MANGRUM, ANGELA DAWN (MED)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9366 GREENWAYS LN
Mailing Address - Street 2:
Mailing Address - City:FANNING SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32693-7684
Mailing Address - Country:US
Mailing Address - Phone:352-221-4790
Mailing Address - Fax:
Practice Address - Street 1:103 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0920
Practice Address - Country:US
Practice Address - Phone:352-439-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor