MEDICARE: JENNIFER CANGEME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	803	SC
2	101YP2500X	Professional Counselor	7874	SC

General Provider Information

NPI Number	:	1619424868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CANGEME

Provider Business Mailing Address
First Line	:	4325 DICK POND RD STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	438-424-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 DICK POND RD STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	843-424-2309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	08/12/2025

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