Healthcare Provider Details

I. General information

NPI: 1578976585
Provider Name (Legal Business Name): ANGELA TALLMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA TALLMAN LPC

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22280 JEB STUART HWY
STUART VA
24171-2999
US

IV. Provider business mailing address

24 CLAY ST
MARTINSVILLE VA
24112-2810
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4361
  • Fax: 276-694-3445
Mailing address:
  • Phone: 276-632-7128
  • Fax: 276-632-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: