Healthcare Provider Details

I. General information

NPI: 1225926751
Provider Name (Legal Business Name): ANGELA WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CRANBROOK CT
GASTON SC
29053-8112
US

IV. Provider business mailing address

107 CRANBROOK CT
GASTON SC
29053-8112
US

V. Phone/Fax

Practice location:
  • Phone: 803-201-2534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12117
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: