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General NPI Number Information
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NPI Number | 1144252545
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Entity Type | Individual
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Provider Name | ANGELA ANNETTE PRIESTER PHD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY STE 2402
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8200
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Country | US
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Telephone | 904-399-0324
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Fax | 904-944-4379
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Provider Business Mailing Address
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Address Line | 6817 SOUTHPOINT PKWY STE 2402
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8200
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Country | US
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Telephone | 904-399-0324
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Fax | 904-944-4379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2850
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2850
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2850
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PY11215
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License Number State | FL
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