Provider Demographics
NPI:1346445673
Name:AUSTIN, ANGELINA (SW)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 POWELL LN
Mailing Address - Street 2:UNIT #708
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3687
Mailing Address - Country:US
Mailing Address - Phone:703-931-1219
Mailing Address - Fax:
Practice Address - Street 1:810 POTOMAC AVE., SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-547-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3021191041C0700X
VA09040025461041C0700X
MD099031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical