Provider Demographics
NPI:1316021884
Name:HARGROW-ANTHONY, ANGELA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:HARGROW-ANTHONY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 J N PEASE PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4544
Mailing Address - Country:US
Mailing Address - Phone:704-717-2800
Mailing Address - Fax:704-717-6200
Practice Address - Street 1:1931 J N PEASE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4544
Practice Address - Country:US
Practice Address - Phone:704-717-2800
Practice Address - Fax:704-717-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2409103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000309Medicaid