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General NPI Number Information
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NPI Number | 1720100746
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Entity Type | Individual
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Provider Name | ANGELA PHAN MA, LPA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 1618 US HWY 1 NORTH
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-9219
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Country | US
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Telephone | 919-247-4750
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 EDENS RIDGE AVE
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City | WAKE FOREST
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State | NC
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Zip | 27587-5172
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Country | US
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Telephone | 919-247-4750
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2472
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License Number State | NC
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