Provider Demographics
NPI:1841965597
Name:OWEN, ANGELA DENISE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:OWEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:W
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:30 LAVAL CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-7051
Mailing Address - Country:US
Mailing Address - Phone:912-656-3966
Mailing Address - Fax:
Practice Address - Street 1:30 LAVAL CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-7051
Practice Address - Country:US
Practice Address - Phone:912-656-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC-0011001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical