Provider Demographics
NPI:1154394195
Name:D'ANGELO, MICHAEL STEVEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 BUCK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4809
Mailing Address - Country:US
Mailing Address - Phone:910-391-2396
Mailing Address - Fax:
Practice Address - Street 1:TROOP MEDICAL CLINIC G
Practice Address - Street 2:2817 RILEY ROAD MCXC-DA
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00020900101YA0400X
PA5823101YM0800X
NJ37PC00318800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional