Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C.1500160 | OH |
NPI | 1003351370 |
---|---|
Provider Name | Elise Angelos |
First Address | Portsmouth, OH 45662-4097 |
Second Address | Portsmouth, OH 45662-4035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2016 |
Last Update Date | 01/08/2019 |