Provider Demographics
NPI:1790223931
Name:COMMUNITY ANGEL FOUNDATION
Entity Type:Organization
Organization Name:COMMUNITY ANGEL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-645-5700
Mailing Address - Street 1:4208 SIX FORKS RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5733
Mailing Address - Country:US
Mailing Address - Phone:919-645-5700
Mailing Address - Fax:800-480-5850
Practice Address - Street 1:4011 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7044
Practice Address - Country:US
Practice Address - Phone:919-844-7755
Practice Address - Fax:800-480-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10292251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health