Individual
ANGELA GAIL SOUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
635 VASS RD, RAEFORD, NC 28376-8412
(901) 670-6567
(910) 904-2931
Mailing address
635 VASS RD, RAEFORD, NC 28376-8412
(901) 670-6567
(910) 904-2931
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NC
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10
—
NC
05
—
17
—
NC
05
—
25
—
NC
05
—
30
—
NC
05
—
32
—
NC
05
—
33
—
NC
05
—
34
—
NC
05
—
347C00000
—
NC
05
—
38
—
NC
Enumeration date
10/24/2007
Last updated
10/27/2007
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