Individual
ANGELA DAWN GLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCP
Contact information
Practice address
306 MAIN ST, LOGAN, WV 25601-3906
(304) 752-7707
(304) 752-0772
Mailing address
701 MADISON AVE, MADISON, WV 25130-1699
(304) 369-1230
(304) 369-6036
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
776
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001715137
BLUECROSS SHIELD PROVIDER
WV
05
—
9202037000
—
WV
Enumeration date
01/05/2007
Last updated
04/17/2025
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