Healthcare Provider Details

I. General information

NPI: 1417542770
Provider Name (Legal Business Name): ANGELA COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9257 HELIX MESA WAY
SPRING VALLEY CA
91977-1210
US

IV. Provider business mailing address

9257 HELIX MESA WAY
SPRING VALLEY CA
91977-1210
US

V. Phone/Fax

Practice location:
  • Phone: 314-288-8846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: