Provider Demographics
NPI:1881932101
Name:RICHARDSON, ANGELA (LPCA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICHARDSON
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 1:5315 CHIPSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2574
Mailing Address - Country:US
Mailing Address - Phone:919-747-9700
Mailing Address - Fax:
Practice Address - Street 1:10520 LIGON MILL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4575
Practice Address - Country:US
Practice Address - Phone:919-263-9592
Practice Address - Fax:919-263-9670
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9679101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor