Provider Demographics
NPI:1346442209
Name:PARKER, ANGELA STALLWORTH (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:STALLWORTH
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 GARDEN HILL DR
Mailing Address - Street 2:303
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6899
Mailing Address - Country:US
Mailing Address - Phone:919-896-4380
Mailing Address - Fax:
Practice Address - Street 1:2510 GARDEN HILL DR
Practice Address - Street 2:303
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6899
Practice Address - Country:US
Practice Address - Phone:919-896-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC1511101YA0400X
NCC0069241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112104Medicaid