Provider Demographics
NPI:1447869177
Name:MONTGOMERY, ANGELA ELAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ELAINE
Last Name:MONTGOMERY
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 1:110 FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057-2061
Mailing Address - Country:US
Mailing Address - Phone:504-453-7142
Mailing Address - Fax:
Practice Address - Street 1:110 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:HAHNVILLE
Practice Address - State:LA
Practice Address - Zip Code:70057-2061
Practice Address - Country:US
Practice Address - Phone:504-453-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty