| Angel Oak Counseling | |
|
3227 Walter Dr Ste 3b Johns Island SC 29455-8171 | |
| (843) 872-5454 | |
| (843) 872-5501 |
| Full Name | Angel Oak Counseling |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3227 Walter Dr Ste 3b, Johns Island, South Carolina |
| Authorized Official Name and Position | Daniel Jay Uderitz (OWNER - PSYCHIATRIST) |
| Authorized Official Contact | 8438725454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Oak Counseling 3227 Walter Dr Ste 3b Johns Island SC 29455-8171 Ph: (843) 872-5454 | Angel Oak Counseling 3227 Walter Dr Ste 3b Johns Island SC 29455-8171 Ph: (843) 872-5454 |
| NPI Number | 1477077329 |
|---|---|
| Provider Enumeration Date | 08/02/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8325313851 |
|---|---|
| Medicare Enrollment ID | O20171009001780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477077329 | NPI | - | NPPES |
| Provider Name | Daniel J Uderitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295963437 PECOS PAC ID: 1658528815 Enrollment ID: I20120823000718 |
| Provider Name | Tasha Rose Ponce |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124650825 PECOS PAC ID: 0648601799 Enrollment ID: I20231218001763 |
| Provider Name | Zoie Alexandra Reviere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679259204 PECOS PAC ID: 8527418466 Enrollment ID: I20231219001564 |
| Provider Name | Cordes Geer Simpson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235454851 PECOS PAC ID: 0244680825 Enrollment ID: I20231221003726 |
| Provider Name | Michael Andrew Malizia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508357534 PECOS PAC ID: 6709237704 Enrollment ID: I20240103003652 |
| Provider Name | Susan Marie Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023797594 PECOS PAC ID: 2365893427 Enrollment ID: I20240112002822 |
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