Provider Demographics
NPI:1952120438
Name:MEANS, ANGELA RENEE (CPSS, CADCR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:MEANS
Suffix:
Gender:F
Credentials:CPSS, CADCR
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:KENYATTA
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPSS, CADCR, CHW
Mailing Address - Street 1:1217 BEACHNUT LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6010
Mailing Address - Country:US
Mailing Address - Phone:980-440-1211
Mailing Address - Fax:
Practice Address - Street 1:1217 BEACHNUT LN
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6010
Practice Address - Country:US
Practice Address - Phone:980-440-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-5563-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist