MEDICARE: ANGELA MARIE KEARNS LPC-A

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	101YM0800X	Mental Health Counselor	8402	SC

General Provider Information

NPI Number	:	1770356610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE KEARNS LPC-A

Provider Business Mailing Address
First Line	:	1121 CLEARSPRING DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 SOUTHGATE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4209
Country	:	US
Telephone Number	:	843-321-8283
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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