Healthcare Provider Details

I. General information

NPI: 1740484377
Provider Name (Legal Business Name): ANGELA RENEE EURY-JOHNSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 WHITEHALL PARK DR STE 300
CHARLOTTE NC
28273-4179
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-9414
  • Fax: 704-384-5735
Mailing address:
  • Phone: 704-384-9414
  • Fax: 704-384-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2157
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: