Healthcare Provider Details

I. General information

NPI: 1083154066
Provider Name (Legal Business Name): ANGELA VINOKUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S. HENRY ST.
DELAWARE OH
43015
US

IV. Provider business mailing address

250 S. HENRY ST
DELAWARE OH
43015-1286
US

V. Phone/Fax

Practice location:
  • Phone: 614-824-9731
  • Fax:
Mailing address:
  • Phone: 740-369-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1500809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: