Provider Demographics
NPI:1700337748
Name:CELESTINE, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 BETHUNE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-1824
Mailing Address - Country:US
Mailing Address - Phone:832-438-9805
Mailing Address - Fax:
Practice Address - Street 1:6822 BETHUNE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-1824
Practice Address - Country:US
Practice Address - Phone:832-438-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor