1013415462 NPI number — MS. ANGELA WHITLOCK LICSW

Table of content: MS. ANGELA WHITLOCK LICSW (NPI 1013415462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013415462 NPI number — MS. ANGELA WHITLOCK LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLOCK
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013415462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1843
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35807-0843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-975-5121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
IRWIN ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
650 HUEBNER RD
Provider Business Practice Location Address City Name:
FORT RILEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-240-7227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  4223G , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 4675C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4223G . This is a "STATE OF ALABAMA BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".