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NPI Code Detail

MEDICARE: ANGELA RAE KING LGSW

MEDICARE: ANGELA RAE KING LGSW
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
1104100000XSocial Worker980WV

General Provider Information

NPI Number : 1720824048
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA RAE KING LGSW
Provider Business Mailing Address
First Line : PO BOX 23679
Second Line :
City : NEW YORK
State : NY
Zip : 10087-0001
Country : US
Telephone Number : 304-460-5123
Fax Number :
Provider Business Practice Location Address
First Line : 1 KENTON DR STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1256
Country : US
Telephone Number : 304-513-3495
Fax Number : 800-734-8498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2024
Last Update Date : 04/15/2026

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Directions to “ ANGELA RAE KING LGSW” Practice Location

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