Healthcare Provider Details

I. General information

NPI: 1558724450
Provider Name (Legal Business Name): GERMAINE MIDDLETON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 CAMPBELL ST
CAMDEN SC
29020-3507
US

IV. Provider business mailing address

176 CANE BRAKE DR
COLUMBIA SC
29223-5486
US

V. Phone/Fax

Practice location:
  • Phone: 803-425-7712
  • Fax:
Mailing address:
  • Phone: 803-378-0687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7429
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCOU.6310 PCI
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCOU.6310 PCI
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCOU.6310 PCI
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: