Healthcare Provider Details

I. General information

NPI: 1083073274
Provider Name (Legal Business Name): ANEDRA CHINA ADC, LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANEDRA CHINA NCC, ADC, LPC

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DICK POND RD STE E
MYRTLE BEACH SC
29588-7286
US

IV. Provider business mailing address

PO BOX 173
KINGSTREE SC
29556-0173
US

V. Phone/Fax

Practice location:
  • Phone: 803-470-3866
  • Fax: 803-373-1541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21164
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606556
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8303
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: