Provider Demographics
NPI:1215770474
Name:DR. AMANDA D'ANGELO, PLLC
Entity type:Organization
Organization Name:DR. AMANDA D'ANGELO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-725-1713
Mailing Address - Street 1:5012 CROWN POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3298
Mailing Address - Country:US
Mailing Address - Phone:252-725-1713
Mailing Address - Fax:
Practice Address - Street 1:127 RACINE DR STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8834
Practice Address - Country:US
Practice Address - Phone:252-725-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty