Provider Demographics
NPI:1447865506
Name:HANCOCK, ANGELA LYNNE (MS, LAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNNE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNNE
Other - Last Name:STAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 E PIMA ST STE E
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5637
Mailing Address - Country:US
Mailing Address - Phone:520-885-1738
Mailing Address - Fax:520-546-1738
Practice Address - Street 1:5700 E PIMA ST STE E
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5637
Practice Address - Country:US
Practice Address - Phone:520-885-1738
Practice Address - Fax:520-546-1738
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC17786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health