Provider Demographics
NPI:1831265420
Name:WIDDICOMBE, ANGELA (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WIDDICOMBE
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:WHITECRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LAC
Mailing Address - Street 1:1008 BURLINGTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5681
Mailing Address - Country:US
Mailing Address - Phone:888-850-4574
Mailing Address - Fax:406-542-2785
Practice Address - Street 1:415 N HIGGINS AVE
Practice Address - Street 2:ROOM 110, HIGGINS PLAZA
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4522
Practice Address - Country:US
Practice Address - Phone:406-360-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1162-LAC101YA0400X
MT603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1162-LACOtherLIC. ADDICTION COUNSELOR
MT603OtherCLINICAL SOCIAL WORKER