Provider Demographics
NPI:1073289906
Name:MIGUEL, ANTONIO PEDRO
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:PEDRO
Last Name:MIGUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3530
Mailing Address - Country:US
Mailing Address - Phone:828-430-9949
Mailing Address - Fax:
Practice Address - Street 1:503 S GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3530
Practice Address - Country:US
Practice Address - Phone:828-430-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health