Healthcare Provider Details

I. General information

NPI: 1568759926
Provider Name (Legal Business Name): ROBERT BRUCE ANGLE III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 STATE FARM ROAD SUITE 404
BOONE NC
28607-4917
US

IV. Provider business mailing address

360 BEECH STREET
NEWLAND NC
28657-0040
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-9007
  • Fax: 828-264-6101
Mailing address:
  • Phone: 828-733-5889
  • Fax: 828-733-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: