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General NPI Number Information
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NPI Number | 1093987778
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Entity Type | Individual
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Provider Name | ANDREA LATRICE SOLOMON LPC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2712 MIDDLEBURG DR STE 207B
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City | COLUMBIA
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State | SC
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Zip | 29204-2445
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Country | US
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Telephone | 843-260-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 MIDDLEBURG DRIVE SUITE 207 B
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City | COLUMBIA
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State | SC
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Zip | 29204-2415
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Country | US
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Telephone | 843-260-3001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6468
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License Number State | SC
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