Healthcare Provider Details

I. General information

NPI: 1477052538
Provider Name (Legal Business Name): ANGELA WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

IV. Provider business mailing address

3201 OLD POST RD
PORTSMOUTH OH
45662-2426
US

V. Phone/Fax

Practice location:
  • Phone: 740-259-7000
  • Fax: 740-259-7001
Mailing address:
  • Phone: 251-382-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number165093
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number165093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: