Provider Demographics
NPI:1568086353
Name:SALAZAR, ANGELICA MARTIN (LCMHC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARTIN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BARRETT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6523
Mailing Address - Country:US
Mailing Address - Phone:919-900-7557
Mailing Address - Fax:
Practice Address - Street 1:3901 BARRETT DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6523
Practice Address - Country:US
Practice Address - Phone:919-900-7552
Practice Address - Fax:919-977-0024
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health