=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265070643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA LINDSEY WORTH MS, LMFTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2019
-----------------------------------------------------
Last Update Date | 12/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14203 SALEM RIDGE RD
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-2437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-095-5545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14203 SALEM RIDGE RD
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-2437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-095-5545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 12202A
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------