Healthcare Provider Details

I. General information

NPI: 1922917673
Provider Name (Legal Business Name): MR. ANDREW HODGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 W RED BAY RD
SUMTER SC
29150-7545
US

IV. Provider business mailing address

149 W RED BAY RD
SUMTER SC
29150-7545
US

V. Phone/Fax

Practice location:
  • Phone: 803-840-7961
  • Fax:
Mailing address:
  • Phone: 803-840-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7648
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: