Individual
ANGELA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPA
Contact information
Practice address
1618 US HWY 1 NORTH, YOUNGSVILLE, NC 27596-9219
(919) 247-4750
Mailing address
1925 EDENS RIDGE AVE, WAKE FOREST, NC 27587-5172
(919) 247-4750
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2472
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139TH
BCBS
NC
05
—
6005851
—
NC
05
—
6107175
—
NC
Enumeration date
04/03/2007
Last updated
12/05/2018
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