Provider Demographics
NPI:1912689225
Name:BAQUEDANO, ANGIE NICOLE (LMFTA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:NICOLE
Last Name:BAQUEDANO
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S WASHINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5450
Mailing Address - Country:US
Mailing Address - Phone:980-484-3470
Mailing Address - Fax:
Practice Address - Street 1:331 S WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5450
Practice Address - Country:US
Practice Address - Phone:980-484-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20003A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist