Provider Demographics
NPI:1942843925
Name:KOSKOSKY, ANGELA (CADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KOSKOSKY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:HAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:3041 ROSEMEADE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4228
Mailing Address - Country:US
Mailing Address - Phone:910-676-1635
Mailing Address - Fax:
Practice Address - Street 1:324 PERSON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5736
Practice Address - Country:US
Practice Address - Phone:910-438-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)