Provider Demographics
NPI:1093056442
Name:COFFEY-WILSON, ANGELA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:COFFEY-WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:COFFEY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1100 RIDGEFIELD BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-6209
Mailing Address - Country:US
Mailing Address - Phone:828-670-7723
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6209
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional