Provider Information for 1811401789
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ANGELA KAREE WALLOGA LCSW
Sex: Female
NPI: 1811401789
Last Updated: 2017-11-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1811401789 | ||||||||
| Enumeration Date | 2017-11-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 107 PROSPERITY AVE SE APT D LEESBURG, VA 20175-4151 United States Phone: 407-252-8330 | Fax: | ||||||||
| Primary Practice Address | 105 E MARKET ST LEESBURG, VA 20176-3112 United States Phone: 703-771-7845 | Fax:703-771-7845 | ||||||||
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