Provider Demographics
NPI:1972735140
Name:NANCE, ANGELENA MARIE (MSW, P-LCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELENA
Middle Name:MARIE
Last Name:NANCE
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1009 MOUNT VERNON AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4897
Mailing Address - Country:US
Mailing Address - Phone:901-827-7006
Mailing Address - Fax:707-282-9362
Practice Address - Street 1:604 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5902
Practice Address - Country:US
Practice Address - Phone:704-226-1352
Practice Address - Fax:704-282-9362
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0052781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical