Healthcare Provider Details

I. General information

NPI: 1710176656
Provider Name (Legal Business Name): ANGELA NANCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W BLDG 1040
JBSA RANDOLPH TX
78150-4800
US

IV. Provider business mailing address

221 3RD ST W
JBSA RANDOLPH TX
78150-4800
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-6308
  • Fax:
Mailing address:
  • Phone: 210-854-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: