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General NPI Number Information
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NPI Number | 1205050903
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Entity Type | Organization
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Legal Business Name | ACTUALIZED CLINICAL SERVICES CONSULTING, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 820 BRINSMERE DRIVE
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City | ELM GROVE
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State | WI
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Zip | 53122
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Country | US
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Telephone | 262-993-5427
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Fax |
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Provider Business Mailing Address
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Address Line | 820 BRINSMERE DRIVE
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City | ELM GROVE
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State | WI
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Zip | 53122
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Country | US
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Telephone | 262-993-5427
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Fax |
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Authorized Official
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Title or Position | OWNER & PRESIDENT
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Name | DR. ANGELA CHRISTINA STANLEY
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Credential | PSY.D.
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Telephone | 262-993-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 930
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License Number State | WV
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