Provider Demographics
NPI:1720163181
Name:MIDDLETON, EDWARD NATHANIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:NATHANIEL
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5929
Mailing Address - Country:US
Mailing Address - Phone:803-397-2029
Mailing Address - Fax:803-750-7744
Practice Address - Street 1:1441 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5929
Practice Address - Country:US
Practice Address - Phone:803-750-8444
Practice Address - Fax:803-750-7744
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional