Provider Demographics
NPI:1306335963
Name:AGGELES, SAMANTHA CLAIRE (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CLAIRE
Last Name:AGGELES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SAMMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 CORRAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5117
Mailing Address - Country:US
Mailing Address - Phone:443-799-0414
Mailing Address - Fax:
Practice Address - Street 1:21 GAMECOCK AVE STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3368
Practice Address - Country:US
Practice Address - Phone:843-640-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health