Provider Demographics
NPI:1457457350
Name:BARRETT, ANGELA DEVONNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DEVONNE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 AMBER RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3560
Mailing Address - Country:US
Mailing Address - Phone:704-795-4864
Mailing Address - Fax:704-720-9065
Practice Address - Street 1:1265 AMBER RD NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5408
Practice Address - Country:US
Practice Address - Phone:704-795-4864
Practice Address - Fax:704-720-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106591Medicaid
NC15141OtherHEALTH DEPARTMENT