Provider Demographics
NPI:1093987778
Name:SOLOMON, ANDREA LATRICE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LATRICE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DRIVE
Mailing Address - Street 2:SUITE 207 B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2415
Mailing Address - Country:US
Mailing Address - Phone:843-260-3001
Mailing Address - Fax:
Practice Address - Street 1:2712 MIDDLEBURG DR STE 207B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2445
Practice Address - Country:US
Practice Address - Phone:843-260-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3000641104OtherWORKER'S COMP
SC322842Medicaid
SC3347Medicare PIN