Doctor Name: | MR. CODRINGTON BANDA |
NPI Number: | 1467862128 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | EDS, MA, LPC-A |
License Number: | 9251 |
Business Practice Address: | 4188 John Gardner Rd Kershaw, SC - 290679178 |
Business Phone Number: | 8038348284 |
Business Fax Number: | |
Mailing Address: | 4188 John Gardner Rd, KERSHAW |
State: | SC |
Postal Code: | 290679178 |
Phone Number: | 8038348284 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2014 |
NPI Last Update Date: | 05/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 9251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |