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General NPI Number Information
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NPI Number | 1184051930
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Entity Type | Organization
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Legal Business Name | ANGEL WORKS, PEDIATRIC AND ADULT COUNSELING
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 406 W MOUNTAIN ST
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City | KERNERSVILLE
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State | NC
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Zip | 27284-2534
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Country | US
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Telephone | 336-596-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 LAUREL BLUFF CIR
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City | HIGH POINT
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State | NC
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Zip | 27265-8173
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Country | US
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Telephone | 336-596-7970
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEISHA C ANGEL
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Credential | LPC
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Telephone | 336-596-7970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8154
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License Number State | NC
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