Provider Demographics
NPI:1740434315
Name:MICOLUCCI, ANGELA JARVIS (LPCS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JARVIS
Last Name:MICOLUCCI
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 KAY BIRD LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8444
Mailing Address - Country:US
Mailing Address - Phone:704-953-4890
Mailing Address - Fax:
Practice Address - Street 1:400 E STATESVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2588
Practice Address - Country:US
Practice Address - Phone:704-360-8486
Practice Address - Fax:704-230-4674
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7147S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional