Healthcare Provider Details

I. General information

NPI: 1629535646
Provider Name (Legal Business Name): ANGELA M VIGLIO LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA M KEMPER

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 5TH AVE
YOUNGSTOWN OH
44504-1605
US

IV. Provider business mailing address

4605 SOUTHERN BLVD
BOARDMAN OH
44512-1536
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone: 513-873-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.162236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: