Provider Demographics
NPI:1174656128
Name:DIDWAY, ANGELA JOY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:DIDWAY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4835
Mailing Address - Country:US
Mailing Address - Phone:828-437-5901
Mailing Address - Fax:828-437-4311
Practice Address - Street 1:1329 SALEM RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-437-5901
Practice Address - Fax:828-437-4311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103474Medicaid