Provider Demographics
NPI:1629149026
Name:OWEN-KILLAR, ANGELA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:OWEN-KILLAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LE PHILLIP CT NE STE D
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1917
Mailing Address - Country:US
Mailing Address - Phone:704-652-1188
Mailing Address - Fax:
Practice Address - Street 1:236 LE PHILLIP CT
Practice Address - Street 2:SUITE D
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1905
Practice Address - Country:US
Practice Address - Phone:704-786-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2091103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046JXOtherBCBS PROVIDER NUMBER