Provider Demographics
NPI:1528191129
Name:PORTER, ANGELA WOOD (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:WOOD
Last Name:PORTER
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 1:5001 PLANTATION GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8570
Mailing Address - Country:US
Mailing Address - Phone:540-815-6908
Mailing Address - Fax:
Practice Address - Street 1:2965 COLONNADE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3557
Practice Address - Country:US
Practice Address - Phone:540-989-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical