Provider Demographics
NPI:1538357983
Name:COLISTRA, ANGELA L (LCAS, LPC, CRC, CS-I)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:COLISTRA
Suffix:
Gender:F
Credentials:LCAS, LPC, CRC, CS-I
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:1627 CHEW ST STE 101
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3648
Practice Address - Country:US
Practice Address - Phone:610-969-4370
Practice Address - Fax:610-969-3023
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6111907101YA0400X
PAPC008999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)