Individual
ANGELA HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 JEFFERSON HWY, LOUISA, VA 23093-6563
(502) 680-2641
Mailing address
115 JEFFERSON HWY, LOUISA, VA 23093-6563
(502) 680-2641
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
01192011
KY
1041C0700X
Clinical Social Worker
Primary
0904009227
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
01/26/2011
Last updated
10/01/2019
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