Healthcare Provider Details

I. General information

NPI: 1912849696
Provider Name (Legal Business Name): ANGELICC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W MAIN ST # 210
DURHAM NC
27701-3217
US

IV. Provider business mailing address

433 W MAIN ST # 210
DURHAM NC
27701-3217
US

V. Phone/Fax

Practice location:
  • Phone: 844-922-6435
  • Fax:
Mailing address:
  • Phone: 844-922-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: QIANA FLEMING
Title or Position: COO
Credential: MSW
Phone: 984-261-8658