Angela Russell
Organization Active NPI Counseling Psychologist · Largo, MD
NPI 1376665992 · NPPES record last updated Jun 25, 2008
Key facts
- NPI
- 1376665992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- LC1591 (MD)
- Legal business name
- ANGELA RUSSELL
- Practice address
- 1300 Mercantile LN
Suite 139-J
Largo, MD 20774-5327 - Phone
- (301) 574-5976
- Fax
- (301) 574-5986
- NPI assigned
- Apr 4, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Angela L Russell, LCPC
- Title
- President
- Phone
- (301) 574-5976
National Provider Directory
Locations
1300 Mercantile Ln
Ste 139J
Largo, MD 20774
Phone (301) 574-5976
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist |
103TC1900X | LC1591 | MD | Yes |
Addresses
Primary practice location
1300 Mercantile LN
Suite 139-J
Largo, MD 20774-5327
Mailing address
16306 Brooktrail CT
Upper Marlboro, MD 20772-3272
Phone (301) 574-5976
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000940700 | Medicaid | MD |
Other names
- In Search Of Peace, Inc.
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All providers in Largo, MD · Counseling Psychologist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.