Provider Demographics
NPI:1700401742
Name:LITTLE ANGELS THERAPY, INC.
Entity Type:Organization
Organization Name:LITTLE ANGELS THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-302-2056
Mailing Address - Street 1:21 RIVER TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3920
Mailing Address - Country:US
Mailing Address - Phone:828-302-2055
Mailing Address - Fax:855-767-7030
Practice Address - Street 1:2121 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3187
Practice Address - Country:US
Practice Address - Phone:828-578-6028
Practice Address - Fax:855-767-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200384Medicaid