Provider Demographics
NPI:1013629500
Name:ALLISON, ANGELICA HOPE (BSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:HOPE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 JEFFERSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8815
Mailing Address - Country:US
Mailing Address - Phone:877-338-2725
Mailing Address - Fax:
Practice Address - Street 1:1109 JEFFERSON RD STE C
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8815
Practice Address - Country:US
Practice Address - Phone:877-338-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTEMP104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty