Provider Demographics
NPI:1235903105
Name:PENNIX, ANGELA CHRISTINE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:PENNIX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3122 GREAT REWARD WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-2312
Mailing Address - Country:US
Mailing Address - Phone:301-437-2002
Mailing Address - Fax:
Practice Address - Street 1:3122 GREAT REWARD WAY
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-2312
Practice Address - Country:US
Practice Address - Phone:301-437-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD226871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical