Provider Demographics
NPI:1013415462
Name:WHITLOCK, ANGELA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1843
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0843
Mailing Address - Country:US
Mailing Address - Phone:256-975-5121
Mailing Address - Fax:
Practice Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:650 HUEBNER RD
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-240-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4223G104100000X
AL4675C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4223GOtherSTATE OF ALABAMA BOARD OF SOCIAL WORK EXAMINERS