Healthcare Provider Details

I. General information

NPI: 1225713498
Provider Name (Legal Business Name): ANGIE MEI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3561
US

IV. Provider business mailing address

11806 ROBERTSON FARM CIR
FAIRFAX VA
22030-5689
US

V. Phone/Fax

Practice location:
  • Phone: 703-870-9107
  • Fax:
Mailing address:
  • Phone: 703-870-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-227654
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: