Provider Demographics
NPI:1912549155
Name:QUIGLEY, ANGELA MOORE (LCMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MOORE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WHITSON HILL LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6858
Mailing Address - Country:US
Mailing Address - Phone:828-310-0742
Mailing Address - Fax:
Practice Address - Street 1:3970 HENRY KAYLOR LN STE A
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-7551
Practice Address - Country:US
Practice Address - Phone:828-310-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14889101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912549155Medicaid