Provider Demographics
NPI:1639615818
Name:PEREZ PENA, ANGIEMIL (MS, NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:ANGIEMIL
Middle Name:
Last Name:PEREZ PENA
Suffix:
Gender:F
Credentials:MS, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3828
Mailing Address - Country:US
Mailing Address - Phone:336-899-8800
Mailing Address - Fax:
Practice Address - Street 1:232 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3828
Practice Address - Country:US
Practice Address - Phone:336-899-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional