Provider Demographics
NPI:1104226240
Name:MCINVALE, ANGELA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCINVALE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ASHLEY TOWN CENTER DR
Mailing Address - Street 2:BLDG. B-203
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5664
Mailing Address - Country:US
Mailing Address - Phone:843-642-4964
Mailing Address - Fax:843-735-7323
Practice Address - Street 1:3030 ASHLEY TOWN CENTER DR.
Practice Address - Street 2:BLDG. B-203
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-642-4964
Practice Address - Fax:843-735-7323
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC4634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid