Individual
ANGELA A MOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
100 PEYTON WAY, CHARLESTON, WV 25314
(304) 720-8466
(304) 720-8463
Mailing address
PO BOX 7310, CHARLESTON, WV 25356-0310
(304) 776-7606
(304) 776-7636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00080368
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP00080368
WV SOCIAL WORK LICENSE
WV
Enumeration date
07/02/2006
Last updated
07/08/2007
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