MEDICARE: MISS ANGELIQUE VATOCO DILWORTH MA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1689820417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELIQUE VATOCO DILWORTH MA

Provider Business Mailing Address
First Line	:	5909 SHELBY OAKS DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-383-9139
Fax Number	:	901-383-8908

Provider Business Practice Location Address
First Line	:	5909 SHELBY OAKS DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-383-9193
Fax Number	:	901-383-8908

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	02/05/2026

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