Provider Demographics
NPI:1225614613
Name:ROWE, ANGGUNA R (MED, NCC,LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGGUNA
Middle Name:R
Last Name:ROWE
Suffix:
Gender:F
Credentials:MED, NCC,LPC
Other - Prefix:MISS
Other - First Name:ANGGUNA
Other - Middle Name:R
Other - Last Name:SUMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:BRADSHAW
Mailing Address - State:WV
Mailing Address - Zip Code:24817-0414
Mailing Address - Country:US
Mailing Address - Phone:304-320-5544
Mailing Address - Fax:
Practice Address - Street 1:10002 MARSHALL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRADSHAW
Practice Address - State:WV
Practice Address - Zip Code:24817
Practice Address - Country:US
Practice Address - Phone:304-320-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
WV2864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool