Angela Phan, MA, LPA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2472 Issued in NC

Practice address

1618 US Hwy 1 North
Youngsville, NC 27596-9219

Phone

(919) 247-4750

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapeutic Resource Associates PA

  • Community/Behavioral Health Agency
  • Youngsville, NC
  • NPI 1144396003

  Psychologist

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1720100746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 EDENS RIDGE AVE",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875172",
            "telephone_number": "919-247-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 US HWY 1 NORTH",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275969219",
            "telephone_number": "919-247-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ANGELA",
        "credential": "MA, LPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005851",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "139TH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107175",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nirali Patel
• Priya Patel, OD
• Kelly Pearce Moore, RN
• Jessica Pegram, LCSWA
• Tyrese Leon Perry
• Dan M Phillips, MD
• Tanya Donnella Pleasent
• Polaris Rehabilitation, LLC
• Powerful Purpose Psychological & Support Services PLLC
• Primus Home Health Solutions LLC

• Psychologist in Youngsville, NC
• Providers in Youngsville, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.