Provider Demographics
NPI:1750006698
Name:DEVAULT, ANGELA RENEE (MSW, CMHT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:DEVAULT
Suffix:
Gender:F
Credentials:MSW, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2634
Mailing Address - Country:US
Mailing Address - Phone:662-449-1971
Mailing Address - Fax:
Practice Address - Street 1:2725 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2634
Practice Address - Country:US
Practice Address - Phone:662-449-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW95691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical