Angela Polite Mack

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

007003996 Issued in SC

Practice address

1109 White Hall Rd
Yemassee, SC 29945-5319

Phone

(843) 437-6280

NPI assigned

Aug 25, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566691200000",
    "number": "1639726532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5631 SPRING VALLEY RD # 149-2",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752543169",
            "telephone_number": "843-437-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 WHITE HALL RD",
            "city": "YEMASSEE",
            "state": "SC",
            "postal_code": "299455319",
            "telephone_number": "843-437-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "ANGELA",
        "middle_name": "POLITE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-25",
        "last_updated": "2019-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "007003996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@angelasopenhearts.com",
            "affiliation": "N",
            "address_1": "1109 White Hall Rd",
            "city": "Yemassee",
            "state": "SC",
            "country_code": "US",
            "postal_code": "299455319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Yemassee, SC
• Providers in Yemassee, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.