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General NPI Number Information
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NPI Number | 1215370499
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Entity Type | Individual
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Provider Name | ANGELA KAYE FORD LCAS-A
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 1037 BULLARD CT SUITE 208
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City | RALEIGH
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State | NC
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Zip | 27615-6871
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Country | US
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Telephone | 919-830-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 203 WENONAH WAY
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City | DURHAM
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State | NC
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Zip | 27713-2463
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Country | US
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Telephone | 919-741-0711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2257-A
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License Number State | NC
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