Healthcare Provider Details

I. General information

NPI: 1265252613
Provider Name (Legal Business Name): SOMMER ANGELA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 AVONSHIRE DR
SUMMERVILLE SC
29483-7355
US

IV. Provider business mailing address

246 AVONSHIRE DR
SUMMERVILLE SC
29483-7355
US

V. Phone/Fax

Practice location:
  • Phone: 573-837-3053
  • Fax:
Mailing address:
  • Phone: 573-837-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9634
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: