Provider Demographics
NPI:1144717596
Name:YOUNG, ANGELA KENNEDY (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KENNEDY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 CALLAHAN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6894
Mailing Address - Country:US
Mailing Address - Phone:832-435-5645
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH HEALTH
Practice Address - Street 2:1604 ROCK PRAIRIE RD
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-764-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW5834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker