Provider Demographics
NPI:1467836114
Name:MCCLANAHAN, ANGELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:MCCLANAHAN
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 1:185 REDWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2599
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:276-546-9701
Practice Address - Street 1:1721 LOVERS GAP RD
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656-9781
Practice Address - Country:US
Practice Address - Phone:276-597-7081
Practice Address - Fax:276-546-9709
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical