Provider Demographics
NPI:1598026353
Name:FLOYD, ANGELA (LCSW, CHT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 GLOSTER CREEK VLG STE D1
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4753
Mailing Address - Country:US
Mailing Address - Phone:662-690-8007
Mailing Address - Fax:662-842-4653
Practice Address - Street 1:499 GLOSTER CREEK VLG STE D1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4753
Practice Address - Country:US
Practice Address - Phone:662-690-8007
Practice Address - Fax:662-842-4653
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC61441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05174088Medicaid