Provider Demographics
NPI:1942845649
Name:KIKER, ANGELA RUTH BROOKS
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RUTH BROOKS
Last Name:KIKER
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 1:7413 INLET PT
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5581
Mailing Address - Country:US
Mailing Address - Phone:571-395-2993
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3866
Practice Address - Country:US
Practice Address - Phone:202-350-1657
Practice Address - Fax:866-391-1787
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009084101Y00000X, 103TC1900X
101YA0400X, 103TC1900X
FL22363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health