Provider Demographics
NPI:1699966598
Name:ROTH, ANGELA MORGAN (BSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MORGAN
Last Name:ROTH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 HONORS ROW SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9338
Mailing Address - Country:US
Mailing Address - Phone:256-426-3753
Mailing Address - Fax:
Practice Address - Street 1:9238 MADISON BLVD
Practice Address - Street 2:BUILDING ONE SUITE 1300
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9100
Practice Address - Country:US
Practice Address - Phone:256-774-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor