Basic Information
| Provider Information | |||||||||
| NPI: | 1508269986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERKINSON | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628962210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189376483 | ||||||||
| FaxNumber: | 6189371440 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 EDWARDS ST | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620023915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184622331 | ||||||||
| FaxNumber: | 6184622504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2014 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 178.00964 | IL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 180.011421 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.