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General NPI Number Information
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NPI Number | 1710767520
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Entity Type | Organization
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Legal Business Name | ANGIE MAYO INC.
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 1816 E 7TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-2416
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Country | US
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Telephone | 815-579-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 SUWARROW CIR
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City | TEGA CAY
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State | SC
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Zip | 29708-9360
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Country | US
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Telephone | 815-579-9578
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST AND CEO
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Name | MRS. ANGELA MAYO
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Credential | LCSW
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Telephone | 815-579-9578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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