MEDICARE: ANGELA BACH

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	101YP2500X	Professional Counselor	0701001567	VA

General Provider Information

NPI Number	:	1740557099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BACH

Provider Business Mailing Address
First Line	:	3600 MERIDALE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1145
Country	:	US
Telephone Number	:	804-840-6176
Fax Number	:	804-272-1571

Provider Business Practice Location Address
First Line	:	3111 NORTHSIDE AVE
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23228-5441
Country	:	US
Telephone Number	:	804-840-6176
Fax Number	:	804-272-1571

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	08/01/2014

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