Provider Demographics
NPI:1285721878
Name:OSMON, ANGELA STARR (LCAS)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:STARR
Last Name:OSMON
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6618
Mailing Address - Country:US
Mailing Address - Phone:772-766-3810
Mailing Address - Fax:252-338-1779
Practice Address - Street 1:1806 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6618
Practice Address - Country:US
Practice Address - Phone:772-766-3810
Practice Address - Fax:252-338-1779
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111793Medicaid