Provider Demographics
NPI:1184037251
Name:ANGEL WORKS, PEDIATRIC AND ADULT COUNSELING
Entity Type:Organization
Organization Name:ANGEL WORKS, PEDIATRIC AND ADULT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEISHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC
Authorized Official - Phone:336-908-8564
Mailing Address - Street 1:233 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2529
Mailing Address - Country:US
Mailing Address - Phone:336-908-8564
Mailing Address - Fax:
Practice Address - Street 1:233 W MOUNTAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2529
Practice Address - Country:US
Practice Address - Phone:336-908-8564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty