Provider Demographics
NPI:1467862128
Name:BANDA, CODRINGTON (EDS, MA, LPC-A)
Entity Type:Individual
Prefix:MR
First Name:CODRINGTON
Middle Name:
Last Name:BANDA
Suffix:
Gender:M
Credentials:EDS, MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 JOHN GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-9178
Mailing Address - Country:US
Mailing Address - Phone:803-834-8284
Mailing Address - Fax:
Practice Address - Street 1:4188 JOHN GARDNER RD
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-9178
Practice Address - Country:US
Practice Address - Phone:803-834-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional