Provider Demographics
NPI:1518439181
Name:NORDEEN, ANGELA CATHERINE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CATHERINE
Last Name:NORDEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-3015
Mailing Address - Country:US
Mailing Address - Phone:843-222-6919
Mailing Address - Fax:843-294-0318
Practice Address - Street 1:3100 DICK POND RD UNIT A
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7286
Practice Address - Country:US
Practice Address - Phone:843-222-6919
Practice Address - Fax:843-294-0318
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6928101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor