Provider Demographics
NPI:1518390988
Name:HARRIS, ANGEL MARIA (LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:MARIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 SHANDA DR
Mailing Address - Street 2:E
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3312
Mailing Address - Country:US
Mailing Address - Phone:910-920-6009
Mailing Address - Fax:
Practice Address - Street 1:6316 SHANDA DR
Practice Address - Street 2:E
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3312
Practice Address - Country:US
Practice Address - Phone:910-920-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3131-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)