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General NPI Number Information
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NPI Number | 1407145063
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Entity Type | Individual
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Provider Name | ANGELA ENLOW
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Gender | Female
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 500 W FORT ST
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City | BOISE
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State | ID
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Zip | 83702-4501
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Country | US
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Telephone | 208-422-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 TUNNEL RD
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City | ASHEVILLE
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State | NC
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Zip | 28805-2576
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4333
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License Number State | NC
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