MEDICARE: ANGELA CALLAHAN LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701006017	VA

General Provider Information

NPI Number	:	1023406204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CALLAHAN LPC, NCC

Provider Business Mailing Address
First Line	:	500 WASHINGTON ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3508
Country	:	US
Telephone Number	:	757-372-7868
Fax Number	:	757-419-5365

Provider Business Practice Location Address
First Line	:	500 WASHINGTON ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3508
Country	:	US
Telephone Number	:	757-372-7868
Fax Number	:	757-419-5365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	12/22/2014

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