Provider Demographics
NPI:1154927903
Name:BRICKLE, ANGELA ROSE (MS CGC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE
Last Name:BRICKLE
Suffix:
Gender:F
Credentials:MS CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 MURRAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1115
Mailing Address - Country:US
Mailing Address - Phone:803-873-6004
Mailing Address - Fax:
Practice Address - Street 1:701 GATEWAY BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7420
Practice Address - Country:US
Practice Address - Phone:877-688-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS