Healthcare Provider Details

I. General information

NPI: 1235425612
Provider Name (Legal Business Name): ANGELA LEE MAYES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MAYES

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRUTCHFIELD ST STE D
DURHAM NC
27704-2771
US

IV. Provider business mailing address

2304 GROVEWOOD RD
CLEARWATER FL
33764-4928
US

V. Phone/Fax

Practice location:
  • Phone: 919-619-0653
  • Fax:
Mailing address:
  • Phone: 919-619-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: