Provider Demographics
NPI:1033688460
Name:RATLIFF-EMRICH, ANGELA (MS LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RATLIFF-EMRICH
Suffix:
Gender:F
Credentials:MS LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JUMPING BRANCH
Mailing Address - State:WV
Mailing Address - Zip Code:25969-6008
Mailing Address - Country:US
Mailing Address - Phone:304-673-4290
Mailing Address - Fax:304-466-9289
Practice Address - Street 1:261 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:JUMPING BRANCH
Practice Address - State:WV
Practice Address - Zip Code:25969-6008
Practice Address - Country:US
Practice Address - Phone:304-673-4290
Practice Address - Fax:304-466-9289
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 106H00000X
WVAP00941100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty