Healthcare Provider Details

I. General information

NPI: 1710899042
Provider Name (Legal Business Name): CANDRA BETH DULINA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 HIGHWAY 90 E UNIT C
LITTLE RIVER SC
29566-9296
US

IV. Provider business mailing address

225 ROYALS CIR
CONWAY SC
29526-2899
US

V. Phone/Fax

Practice location:
  • Phone: 843-421-9511
  • Fax:
Mailing address:
  • Phone: 843-421-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10881
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: