MEDICARE: MS. ANGELA STARR OSMON LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	206	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285721878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA STARR OSMON LCAS

Provider Business Mailing Address
First Line	:	1806 EDGEWOOD DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6618
Country	:	US
Telephone Number	:	772-766-3810
Fax Number	:	252-338-1779

Provider Business Practice Location Address
First Line	:	1806 EDGEWOOD DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6618
Country	:	US
Telephone Number	:	772-766-3810
Fax Number	:	252-338-1779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/06/2012

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