MEDICARE: COMMUNITY ANGEL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	10292	NC

General Provider Information

NPI Number	:	1790223931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ANGEL FOUNDATION

Provider Business Mailing Address
First Line	:	4208 SIX FORKS RD
Second Line	:	SUITE 1000
City	:	RALEIGH
State	:	NC
Zip	:	27609-5733
Country	:	US
Telephone Number	:	919-645-5700
Fax Number	:	800-480-5850

Provider Business Practice Location Address
First Line	:	4011 VILLAGE PARK DR
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	919-844-7755
Fax Number	:	800-480-5850

Authorized Official
Title or Position	:	FOUNDER
Name	:	CHRISTAL CARMICHAEL
Credential	:	LPC
Telephone Number	:	919-645-5700

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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Directions to “COMMUNITY ANGEL FOUNDATION ” Practice Location

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