Provider Demographics
NPI:1578264875
Name:NIBLETT, ANGELA C
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:NIBLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PARK OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4920
Mailing Address - Country:US
Mailing Address - Phone:703-346-5327
Mailing Address - Fax:
Practice Address - Street 1:9675 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3762
Practice Address - Country:US
Practice Address - Phone:571-341-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker