Provider Demographics
NPI:1689721037
Name:GASTON, ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GASTON
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 1:209 E MULBERRY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4751
Mailing Address - Country:US
Mailing Address - Phone:979-331-3124
Mailing Address - Fax:979-331-3123
Practice Address - Street 1:209 E MULBERRY ST STE 400
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4751
Practice Address - Country:US
Practice Address - Phone:979-331-3124
Practice Address - Fax:979-331-3123
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS203281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S74WMedicare ID - Type Unspecified