Provider Demographics
NPI:1033969258
Name:BURNETT, ANGEL F
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:F
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 S WALNUT CREEK PKWY APT O
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3840
Mailing Address - Country:US
Mailing Address - Phone:191-228-9776
Mailing Address - Fax:
Practice Address - Street 1:223 E CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3475
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:866-500-2186
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician