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General NPI Number Information
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NPI Number | 1811401789
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Entity Type | Individual
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Provider Name | ANGELA KAREE WALLOGA LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 105 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-3112
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Country | US
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Telephone | 703-771-7845
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Fax | 703-771-7845
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Provider Business Mailing Address
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Address Line | 107 PROSPERITY AVE SE APT D
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City | LEESBURG
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State | VA
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Zip | 20175-4151
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Country | US
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Telephone | 407-252-8330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010188
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License Number State | VA
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