Provider Demographics
NPI:1700133683
Name:TALLEY, ANGELICA T (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:T
Last Name:TALLEY
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 1:1715 E WILSHIRE AVE STE 706
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4652
Mailing Address - Country:US
Mailing Address - Phone:714-547-7931
Mailing Address - Fax:
Practice Address - Street 1:1715 E WILSHIRE AVE STE 706
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4652
Practice Address - Country:US
Practice Address - Phone:714-547-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical