Provider Demographics
NPI:1841649381
Name:THOMAS, ANGELA S (LADC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
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Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:ATTN: LINDA RANGEL
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-293-9737
Practice Address - Street 1:421 E HICKORY ST
Practice Address - Street 2:SUITE 402
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2635
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-293-9737
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN303332101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)