Provider Demographics
NPI:1093458226
Name:ANGELA CHOP PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:ANGELA CHOP PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BEAN
Authorized Official - Last Name:CHOP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:980-288-5219
Mailing Address - Street 1:3149 PLANTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-1682
Mailing Address - Country:US
Mailing Address - Phone:980-288-5219
Mailing Address - Fax:877-599-4198
Practice Address - Street 1:6201 FAIRVIEW RD STE 200#8539
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3297
Practice Address - Country:US
Practice Address - Phone:980-288-5219
Practice Address - Fax:877-599-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty