Active NPI
Dora L Angevine, LPC
- Professional Counselor
- Saint Louis, MO
National Provider Identifier
1023464948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C4910
- Practice address
- 7036 Julian Ave
Saint Louis, MO 63130-1938 - Phone
- (314) 514-5107
- NPI assigned
- May 10, 2016
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2019002608 | MO | |
| Professional Counselor | 101YP2500X | C4910 | OR | Primary |
Addresses
Primary practice location
7036 Julian Ave
Saint Louis, MO 63130-1938
Mailing address
7036 Julian Ave
Saint Louis, MO 63130-1938
Phone (314) 514-5107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 29, 2024 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019002608 | MO | MD | Professional Counselor |
| C4910 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742256000000",
"number": "1023464948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7036 JULIAN AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631301938",
"telephone_number": "314-514-5107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7036 JULIAN AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631301938",
"telephone_number": "314-514-5107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANGEVINE",
"first_name": "DORA",
"middle_name": "L",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2016-05-10",
"last_updated": "2025-03-18",
"certification_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2019002608",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C4910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.