Provider Demographics
NPI:1073234282
Name:SMITH, ANGELA TILLMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TILLMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10263 MATTHEWS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5151
Mailing Address - Country:US
Mailing Address - Phone:804-922-2210
Mailing Address - Fax:
Practice Address - Street 1:10263 MATTHEWS GROVE LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-5151
Practice Address - Country:US
Practice Address - Phone:804-922-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040080411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical