Provider Demographics
NPI:1679717607
Name:HOUSER-BETTI, ANGELA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DAWN
Last Name:HOUSER-BETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 W HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-9682
Mailing Address - Country:US
Mailing Address - Phone:704-789-3146
Mailing Address - Fax:
Practice Address - Street 1:4425 RANDOLPH RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2351
Practice Address - Country:US
Practice Address - Phone:704-789-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3197103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent