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General NPI Number Information
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NPI Number | 1740434315
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Entity Type | Individual
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Provider Name | ANGELA JARVIS MICOLUCCI LCMHCS
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Gender | Female
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 400 E STATESVILLE AVE STE 200
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City | MOORESVILLE
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State | NC
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Zip | 28115-2588
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Country | US
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Telephone | 704-360-8486
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Fax | 704-230-4674
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Provider Business Mailing Address
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Address Line | 2498 SMITH HARBOUR DR
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City | DENVER
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State | NC
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Zip | 28037-8088
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Country | US
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Telephone | 704-953-4890
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7147S
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License Number State | NC
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