Provider Demographics
NPI:1447538194
Name:POLK, ANGELA
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:VINCENT
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1919 MARKET ST UNIT 110
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2751
Mailing Address - Country:US
Mailing Address - Phone:510-395-5083
Mailing Address - Fax:
Practice Address - Street 1:2450 VALDEZ ST UNIT 612
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3163
Practice Address - Country:US
Practice Address - Phone:510-395-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health