Provider Demographics
NPI:1326312141
Name:WEAVER, ANGELA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:WEAVER
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 1:3131 SANGUINET ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5336
Mailing Address - Country:US
Mailing Address - Phone:817-255-2652
Mailing Address - Fax:817-255-2657
Practice Address - Street 1:2700 AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2332
Practice Address - Country:US
Practice Address - Phone:817-332-6329
Practice Address - Fax:817-332-2828
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical