Provider Demographics
NPI:1790956431
Name:VIESCA, ANGELA RUSSELL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RUSSELL
Last Name:VIESCA
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 1:16401 MARTHAS CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3023
Mailing Address - Country:US
Mailing Address - Phone:512-293-4346
Mailing Address - Fax:512-293-4346
Practice Address - Street 1:600 ROUND ROCK WEST DR STE 606
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5005
Practice Address - Country:US
Practice Address - Phone:512-293-4346
Practice Address - Fax:512-300-0592
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS213471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical