Provider Demographics
NPI:1639852841
Name:VICK, ANGELA UNETTE (CERTIFIED NURSE ASSI)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:UNETTE
Last Name:VICK
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASSI
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:UNETTE
Other - Last Name:VICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:706 JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8915
Mailing Address - Country:US
Mailing Address - Phone:252-469-1742
Mailing Address - Fax:
Practice Address - Street 1:706 JASMINE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8915
Practice Address - Country:US
Practice Address - Phone:252-469-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician