Provider Demographics
NPI:1023406204
Name:CALLAHAN, ANGELA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3508
Mailing Address - Country:US
Mailing Address - Phone:757-372-7868
Mailing Address - Fax:757-419-5365
Practice Address - Street 1:500 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3508
Practice Address - Country:US
Practice Address - Phone:757-372-7868
Practice Address - Fax:757-419-5365
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health