Provider Demographics
NPI:1558856591
Name:O'ROURKE, ANGELA M (LPCS/C, NCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LPCS/C, NCC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCS/C, NCC
Mailing Address - Street 1:1495 REMOUNT RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3320
Mailing Address - Country:US
Mailing Address - Phone:843-882-6880
Mailing Address - Fax:843-892-0394
Practice Address - Street 1:1495 REMOUNT RD STE 3A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3320
Practice Address - Country:US
Practice Address - Phone:843-882-6880
Practice Address - Fax:843-892-0394
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6837101YM0800X
SC7454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2243Medicaid
SCPG1456Medicaid
SCPC2113Medicaid