Provider Demographics
NPI:1346442209
Name:PARKER, ANGELA STALLWORTH (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:STALLWORTH
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 7315
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96297
Mailing Address - Country:US
Mailing Address - Phone:315-737-5177
Mailing Address - Fax:
Practice Address - Street 1:BLDG 7315
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96297
Practice Address - Country:US
Practice Address - Phone:315-737-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1511101YA0400X
101YM0800X
NCC0069241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112104Medicaid