Healthcare Provider Details

I. General information

NPI: 1447943253
Provider Name (Legal Business Name): ANGLIQUE MARIE RICH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ADLEY WAY
GREENVILLE SC
29607-6511
US

IV. Provider business mailing address

225 ADLEY WAY
GREENVILLE SC
29607-6511
US

V. Phone/Fax

Practice location:
  • Phone: 864-987-9747
  • Fax: 864-987-9770
Mailing address:
  • Phone: 864-987-9747
  • Fax: 864-987-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27500
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: