Provider Demographics
NPI:1720618804
Name:CONWAY, ANGELA DEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DEE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15476 YARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3351
Mailing Address - Country:US
Mailing Address - Phone:901-283-6872
Mailing Address - Fax:
Practice Address - Street 1:15476 YARBERRY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3351
Practice Address - Country:US
Practice Address - Phone:901-283-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty