=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811433147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ANGWIN LICSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2017
-----------------------------------------------------
Last Update Date | 08/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 PERIMETER PARK S STE 114
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-475-3479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5210 MOUNTAIN VALLEY RD
-----------------------------------------------------
City | HUEYTOWN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35023-3768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-475-3479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4328C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------