Provider Demographics
NPI:1083931190
Name:PAYTON-HARMON, ANGEL LATIECE (MSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:LATIECE
Last Name:PAYTON-HARMON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 SOUTHERN MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7486
Mailing Address - Country:US
Mailing Address - Phone:843-813-9603
Mailing Address - Fax:843-792-5127
Practice Address - Street 1:1377 SOUTHERN MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7486
Practice Address - Country:US
Practice Address - Phone:843-813-9603
Practice Address - Fax:843-792-5127
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5475171M00000X
SC0008763404172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver