Healthcare Provider Details

I. General information

NPI: 1871190272
Provider Name (Legal Business Name): ANGEL HOWARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

4600 WHITESTONE DR
NORTH CHESTERFIELD VA
23234-3623
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8000
  • Fax:
Mailing address:
  • Phone: 804-592-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012386
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: