Provider Demographics
NPI:1942025200
Name:HOWARD, ANGELA JACKMAN (ALC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JACKMAN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 NOTTINGHAM LN SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1120
Mailing Address - Country:US
Mailing Address - Phone:256-348-9553
Mailing Address - Fax:
Practice Address - Street 1:3315 MEMORIAL PKWY SW STE 501
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5353
Practice Address - Country:US
Practice Address - Phone:256-361-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health