Healthcare Provider Details

I. General information

NPI: 1649488206
Provider Name (Legal Business Name): ANGELA C CHAMBERS MA, ADC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W MAPLE AVE
FAYETTEVILLE WV
25840-1413
US

IV. Provider business mailing address

209 W MAPLE AVE
FAYETTEVILLE WV
25840-1413
US

V. Phone/Fax

Practice location:
  • Phone: 304-574-2100
  • Fax:
Mailing address:
  • Phone: 681-220-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00941490
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: