Provider Demographics
NPI:1679820922
Name:FIVEK, ANGELA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:FIVEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502-F BOXWOOD LANE
Mailing Address - Street 2:APT. F
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4217
Mailing Address - Country:US
Mailing Address - Phone:919-648-7320
Mailing Address - Fax:
Practice Address - Street 1:502-F BOXWOOD LANE
Practice Address - Street 2:APT. F
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4217
Practice Address - Country:US
Practice Address - Phone:919-648-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8890101YP2500X
NC8890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional