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Individual

ANGELA DE VARONA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1702 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
(336) 659-8301
(336) 659-9361
Mailing address
1702 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
(336) 659-8301
(336) 659-9361

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
045U0
BLUECROSSPROVIDER#
NC
01
1897
NC PSYCHOLOGY LICENSE#
NC
Enumeration date
08/23/2006
Last updated
02/02/2012
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