Individual
ANGELA M ELLIS-LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
28 MALLARD CT, BECKLEY, WV 25801-3664
(304) 252-8409
Mailing address
101 BILL BAKER WAY, BECKLEY, WV 25801-1505
(304) 252-8324
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00944946
WV
Other
Enumeration date
09/21/2022
Last updated
09/28/2022
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