Provider Demographics
NPI:1902151194
Name:ANGELS DREAM FOUNDATION
Entity Type:Organization
Organization Name:ANGELS DREAM FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:DELGADO
Authorized Official - Last Name:CUSTODIO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:401-499-6558
Mailing Address - Street 1:1800 CAMDEN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4690
Mailing Address - Country:US
Mailing Address - Phone:401-499-6558
Mailing Address - Fax:
Practice Address - Street 1:1800 CAMDEN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4690
Practice Address - Country:US
Practice Address - Phone:401-499-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty