Provider Demographics
NPI:1811401789
Name:WALLOGA, ANGELA KAREE (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAREE
Last Name:WALLOGA
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 1:107 PROSPERITY AVE SE APT D
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4151
Mailing Address - Country:US
Mailing Address - Phone:407-252-8330
Mailing Address - Fax:
Practice Address - Street 1:105 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3112
Practice Address - Country:US
Practice Address - Phone:703-771-7845
Practice Address - Fax:703-771-7845
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical