Healthcare Provider Details

I. General information

NPI: 1285133876
Provider Name (Legal Business Name): ANGELA LYNN MITCHELL SUDP, LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FIR ST
LONGVIEW WA
98632-2544
US

IV. Provider business mailing address

PO BOX 2429
LONGVIEW WA
98632-8486
US

V. Phone/Fax

Practice location:
  • Phone: 360-575-3316
  • Fax: 360-353-9440
Mailing address:
  • Phone: 360-353-9494
  • Fax: 360-355-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWIA.SC.70117779
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60983348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: