Provider Demographics
NPI:1871134999
Name:ELLISON, ANGELA SUE (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:ELLISON
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 1:1527 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1889
Mailing Address - Country:US
Mailing Address - Phone:606-465-3245
Mailing Address - Fax:
Practice Address - Street 1:1527 VALLEY DR
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1889
Practice Address - Country:US
Practice Address - Phone:606-465-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2543961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical