Provider Demographics
NPI:1750770616
Name:FORD, ANNETTE LOUISE
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LOUISE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5731
Mailing Address - Country:US
Mailing Address - Phone:843-332-1009
Mailing Address - Fax:843-332-1199
Practice Address - Street 1:200 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5731
Practice Address - Country:US
Practice Address - Phone:843-332-1009
Practice Address - Fax:843-332-1009
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health