Healthcare Provider Details

I. General information

NPI: 1700401742
Provider Name (Legal Business Name): LITTLE ANGELS THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 12TH AVE NE
HICKORY NC
28601-3187
US

IV. Provider business mailing address

21 RIVER TERRACE CT
TAYLORSVILLE NC
28681-3920
US

V. Phone/Fax

Practice location:
  • Phone: 828-578-6028
  • Fax: 855-767-7030
Mailing address:
  • Phone: 828-302-2055
  • Fax: 855-767-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DOYLE FORD
Title or Position: VP
Credential:
Phone: 828-302-2056