Provider Demographics
NPI:1689428401
Name:DUNNAM, ANGELA WHITE (LICSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:WHITE
Last Name:DUNNAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20151 PATTY JR LN
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-5442
Mailing Address - Country:US
Mailing Address - Phone:251-620-8404
Mailing Address - Fax:
Practice Address - Street 1:20151 PATTY JR LN
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-5442
Practice Address - Country:US
Practice Address - Phone:251-620-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0977C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical