Healthcare Provider Details

I. General information

NPI: 1518239680
Provider Name (Legal Business Name): ANGELA D GROSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

IV. Provider business mailing address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

V. Phone/Fax

Practice location:
  • Phone: 423-454-4866
  • Fax: 423-602-9796
Mailing address:
  • Phone: 423-454-4866
  • Fax: 423-602-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC1587
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: