Provider Demographics
NPI:1477077329
Name:UDERITZ FAMILY PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:UDERITZ FAMILY PSYCHIATRY, LLC
Other - Org Name:ANGEL OAK COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:UDERITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-872-5454
Mailing Address - Street 1:3227 WALTER DR STE 3B
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8171
Mailing Address - Country:US
Mailing Address - Phone:843-872-5454
Mailing Address - Fax:843-872-5501
Practice Address - Street 1:3227 WALTER DR STE 3B
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8171
Practice Address - Country:US
Practice Address - Phone:843-872-5454
Practice Address - Fax:843-872-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC344782084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty