Healthcare Provider Details

I. General information

NPI: 1952883811
Provider Name (Legal Business Name): ANGELA MARTIN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WHITESTICK ST PO BOX 46
MABSCOTT WV
25871-0046
US

IV. Provider business mailing address

197 PEBBLESTONE DR
BECKLEY WV
25801-9524
US

V. Phone/Fax

Practice location:
  • Phone: 304-731-0925
  • Fax: 304-254-8719
Mailing address:
  • Phone: 304-731-0925
  • Fax: 304-254-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP00941029
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCP00941029
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: