Provider Demographics
NPI:1831782895
Name:BOYER, ANGELA MICHELLE (SUDP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:BOYER
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 WARREN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1467
Mailing Address - Country:US
Mailing Address - Phone:360-286-6338
Mailing Address - Fax:
Practice Address - Street 1:400 WARREN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1467
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61121181101YA0400X
WACP61385841101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)