Provider Demographics
NPI:1477532505
Name:LICHTY, ANGIE WARD (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:WARD
Last Name:LICHTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ANGIE
Other - Middle Name:DAWN
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2316
Mailing Address - Country:US
Mailing Address - Phone:864-941-8100
Mailing Address - Fax:864-388-1052
Practice Address - Street 1:1911 THURMOND MALL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2375
Practice Address - Country:US
Practice Address - Phone:803-799-5390
Practice Address - Fax:803-799-5391
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS