Provider Demographics
NPI:1174826168
Name:NILES, DEANGELA JOI (LPC)
Entity Type:Individual
Prefix:DR
First Name:DEANGELA
Middle Name:JOI
Last Name:NILES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:DEANGELA
Other - Middle Name:JOI NILES
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAS C-4506
Mailing Address - Street 1:1450 RABON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5875
Mailing Address - Country:US
Mailing Address - Phone:386-916-9733
Mailing Address - Fax:
Practice Address - Street 1:1450 RABON FARMS LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5875
Practice Address - Country:US
Practice Address - Phone:386-916-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-4506101YA0400X
GA003093LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)