Provider Demographics
NPI:1831392257
Name:BROCK, ANGEL (LPCC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNTY RD 68
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964
Mailing Address - Country:US
Mailing Address - Phone:330-532-4216
Mailing Address - Fax:330-385-3588
Practice Address - Street 1:45875 BELL SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-8728
Practice Address - Country:US
Practice Address - Phone:330-397-6007
Practice Address - Fax:234-254-5655
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHE.2102358-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor