Provider Demographics
NPI:1477797587
Name:GILSTRAP, ANGIE WATERS (MED)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:WATERS
Last Name:GILSTRAP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N MAIN ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5661
Mailing Address - Country:US
Mailing Address - Phone:864-933-3077
Mailing Address - Fax:
Practice Address - Street 1:121 N MAIN ST UNIT 301
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5661
Practice Address - Country:US
Practice Address - Phone:864-933-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health