Provider Demographics
NPI:1134450760
Name:ANDERSON, ANGELA DAWN (LPCC, CT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPCC, CT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:STREB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4419 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1233
Mailing Address - Country:US
Mailing Address - Phone:330-345-8450
Mailing Address - Fax:330-345-5899
Practice Address - Street 1:4419 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1233
Practice Address - Country:US
Practice Address - Phone:330-345-8450
Practice Address - Fax:330-345-5899
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0800521-TEMP101YM0800X, 101YP2500X
OHE.0800521101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3065874Medicaid