Individual
AMANDA O'TOOLE HENEAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2772
Mailing address
135 PAYNEHURST DR, LEXINGTON, SC 29072-7142
(803) 391-1993
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
225811
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
25565
SC
Other
Enumeration date
02/26/2021
Last updated
12/06/2023
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