Provider Demographics
NPI:1861818874
Name:DR. ANGELA HOUSER-BETTI, PSYD, PLLC
Entity Type:Organization
Organization Name:DR. ANGELA HOUSER-BETTI, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER-BETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-789-3146
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 STE 208
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2324
Practice Address - Country:US
Practice Address - Phone:704-789-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3197103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty