Provider Demographics
NPI:1780821082
Name:PENNY, ANGELA K (MHCS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:PENNY
Suffix:
Gender:F
Credentials:MHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S CASHUA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5410
Mailing Address - Country:US
Mailing Address - Phone:843-667-5017
Mailing Address - Fax:843-667-9950
Practice Address - Street 1:511 S CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5410
Practice Address - Country:US
Practice Address - Phone:843-667-5017
Practice Address - Fax:843-667-9950
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC246ZA2600X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4433990001OtherDMEPOS