Provider Demographics
NPI:1346268752
Name:WILLERS, ANGELA ALTMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ALTMAN
Last Name:WILLERS
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 1:202 N CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5123
Mailing Address - Country:US
Mailing Address - Phone:229-226-1353
Mailing Address - Fax:
Practice Address - Street 1:202 N CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5123
Practice Address - Country:US
Practice Address - Phone:229-226-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0020231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBDPBMedicare ID - Type Unspecified