Healthcare Provider Details

I. General information

NPI: 1790714889
Provider Name (Legal Business Name): ANGELA MARIE GUPTA-THOMAS PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 OLD MACEDONIA RD
SALUDA NC
28773-9601
US

IV. Provider business mailing address

110 OLD MACEDONIA RD
SALUDA NC
28773-9601
US

V. Phone/Fax

Practice location:
  • Phone: 828-708-0953
  • Fax:
Mailing address:
  • Phone: 828-708-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: