Healthcare Provider Details

I. General information

NPI: 1548080690
Provider Name (Legal Business Name): ANGELIKA KUDLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 NORTHCROSS DR STE G2
HUNTERSVILLE NC
28078-5005
US

IV. Provider business mailing address

113 GADDIS DR
MT HOLLY NC
28120-1421
US

V. Phone/Fax

Practice location:
  • Phone: 704-896-7776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: