Provider Demographics
NPI:1477538957
Name:TUTTLE, ANGELA DUNCAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DUNCAN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEIGH
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:791 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1252
Practice Address - Country:US
Practice Address - Phone:336-716-4551
Practice Address - Fax:336-716-9642
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
130P1OtherBCBS
NC6002776Medicaid
98887OtherMEDCOST
800013764OtherRR MEDICARE
NC2873206AOtherMEDICARE
800013764OtherRR MEDICARE