Provider Demographics
NPI:1093445652
Name:MEYER, ANGELIQUE S
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:S
Last Name:MEYER
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 1:16717 US HIGHWAY 17 STE 210
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3239
Mailing Address - Country:US
Mailing Address - Phone:910-599-2230
Mailing Address - Fax:
Practice Address - Street 1:16717 US HIGHWAY 17 STE 210
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3239
Practice Address - Country:US
Practice Address - Phone:910-599-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst