Provider Demographics
NPI:1013944644
Name:MAULDIN, ANGELA WALL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:WALL
Last Name:MAULDIN
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 1:239 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:NC
Mailing Address - Zip Code:28634-9448
Mailing Address - Country:US
Mailing Address - Phone:704-928-7360
Mailing Address - Fax:704-919-5731
Practice Address - Street 1:239 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:NC
Practice Address - Zip Code:28634-9448
Practice Address - Country:US
Practice Address - Phone:704-928-7360
Practice Address - Fax:704-919-5731
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical