Provider Demographics
NPI:1043355332
Name:VIA, ANGELA MAE (MA, LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MAE
Last Name:VIA
Suffix:
Gender:F
Credentials:MA, LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2311
Mailing Address - Country:US
Mailing Address - Phone:304-526-9189
Mailing Address - Fax:304-526-9989
Practice Address - Street 1:1225 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2311
Practice Address - Country:US
Practice Address - Phone:304-526-9189
Practice Address - Fax:304-526-9989
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist