Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4962 | SC |
Y | 101YP2500X | Professional Counselor | 4962 | SC |
N | 102L00000X | Psychologist | 4962 | SC |
N | 103T00000X | Psychologist | 4962 | SC |
NPI | 1003069915 |
---|---|
Provider Name | Mr. Carlton A Andrews III |
First Address | Columbia, SC 29201-1749 |
Second Address | Columbia, SC 29201-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 23/10/2008 |