Provider Demographics
NPI:1992930788
Name:WILEY, ANGELA (LPC, LCAS, MAC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPC, LCAS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 W FRIENDLY AVE
Mailing Address - Street 2:SUITE B-103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4274
Mailing Address - Country:US
Mailing Address - Phone:336-698-6723
Mailing Address - Fax:
Practice Address - Street 1:4112 SPRING GARDEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1684
Practice Address - Country:US
Practice Address - Phone:336-698-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health