Provider Demographics
NPI:1013374776
Name:GEDDES, ANGELA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:GEDDES
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SLABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5006
Mailing Address - Country:US
Mailing Address - Phone:843-606-0136
Mailing Address - Fax:
Practice Address - Street 1:505 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5006
Practice Address - Country:US
Practice Address - Phone:843-606-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21189594103TS0200X
SC545684103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool