Healthcare Provider Details

I. General information

NPI: 1811834948
Provider Name (Legal Business Name): ANGEL MCCLEESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FALLS DR NW STE 353
ABINGDON VA
24210-8093
US

IV. Provider business mailing address

1144 HORN MOUNTAIN RD
RAVEN VA
24639-7569
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: