Healthcare Provider Details

I. General information

NPI: 1548764582
Provider Name (Legal Business Name): ANGELO LUIS CABRERA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 MIDLOTHIAN TPKE STE 203
NORTH CHESTERFIELD VA
23235-5247
US

IV. Provider business mailing address

5300 NEWBYS WOOD TRL
CHESTERFIELD VA
23832-7500
US

V. Phone/Fax

Practice location:
  • Phone: 229-412-8125
  • Fax: 804-621-2292
Mailing address:
  • Phone: 804-836-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701007627
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007627
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberXXXXXXXXXXX
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: