Provider Demographics
NPI:1235482621
Name:HINTON-ANDREWS, MATILDA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:ANN
Last Name:HINTON-ANDREWS
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 1:1505 HERITAGE LN STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3141
Mailing Address - Country:US
Mailing Address - Phone:843-667-1905
Mailing Address - Fax:843-667-1723
Practice Address - Street 1:1505 HERITAGE LN STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:843-667-1905
Practice Address - Fax:843-667-1723
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6572101YM0800X
NC10702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1235482621Medicaid