Provider Demographics
NPI:1194414508
Name:CROSS, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 LOWER MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064
Mailing Address - Country:US
Mailing Address - Phone:304-542-4214
Mailing Address - Fax:
Practice Address - Street 1:1015 LOWER MIDWAY DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064
Practice Address - Country:US
Practice Address - Phone:304-542-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator