Provider Demographics
NPI:1932583846
Name:HARVEY, ANGELA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTRAL AVE
Mailing Address - Street 2:BLDG 200 A SUITE 17
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3043
Mailing Address - Country:US
Mailing Address - Phone:843-972-7662
Mailing Address - Fax:
Practice Address - Street 1:531 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3043
Practice Address - Country:US
Practice Address - Phone:907-687-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6007101YP2500X
SC6457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1718Medicaid