Provider Demographics
NPI:1952456469
Name:ONLEY-LIVINGSTON, ANGEL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:
Last Name:ONLEY-LIVINGSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:ONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:202 ELM ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5161
Mailing Address - Country:US
Mailing Address - Phone:843-254-2511
Mailing Address - Fax:
Practice Address - Street 1:900B MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4063
Practice Address - Country:US
Practice Address - Phone:843-254-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1389Medicaid