Provider Demographics
NPI:1750895777
Name:DEAN-MOORE, ANGEL (LPCA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DEAN-MOORE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 QUADE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-7401
Mailing Address - Country:US
Mailing Address - Phone:919-467-0537
Mailing Address - Fax:
Practice Address - Street 1:107 QUADE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-7401
Practice Address - Country:US
Practice Address - Phone:919-467-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional