Deidra Williams Angulo, PSD, LISAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Mesa, AZ
NPI 1902408255 · NPPES record last updated Nov 11, 2020
Key facts
- NPI
- 1902408255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 11653 (AZ)
- Practice address
- 5704 E Gable Ave
Mesa, AZ 85206-6714 - Phone
- (602) 524-1986
- NPI assigned
- Nov 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11653 | AZ | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11653 | AZ | Yes |
Addresses
Primary practice location
5704 E Gable Ave
Mesa, AZ 85206-6714
Mailing address
5704 E Gable Ave
Mesa, AZ 85206-6714
Phone (602) 524-1986
Other providers in Mesa, AZ
- Angels on Wheels Nemt LLC
- Eric Nelson Anger III
- Julie Angileri
- Alison Anglen
- Laurie Angood
- Julio F. Angulo
- Karyn Angulo
- Anthony Ikechukwu Ani
- Aniket Vadnerkar PLLC
- Ankur M Bant PLLC
All providers in Mesa, AZ · Addiction (Substance Use Disorder) Counselor in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2020. 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.