Provider Demographics
NPI:1356645436
Name:MOSES, ANGELA D (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:MOSES
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 1:2401 N CARL ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2127
Mailing Address - Country:US
Mailing Address - Phone:501-463-1327
Mailing Address - Fax:501-242-4016
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3737
Practice Address - Country:US
Practice Address - Phone:501-463-1327
Practice Address - Fax:501-242-4016
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty