Healthcare Provider Details

I. General information

NPI: 1497975098
Provider Name (Legal Business Name): ANGIE B. PRINCE M.ED., SR. L.P.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SUBURBAN RD
KNOXVILLE TN
37923-5552
US

IV. Provider business mailing address

204 SUBURBAN RD
KNOXVILLE TN
37923-5552
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-8728
  • Fax: 865-531-8787
Mailing address:
  • Phone: 865-531-8728
  • Fax: 865-531-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPE0000000761
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: