Provider Demographics
NPI:1063166577
Name:RAGIN, ANIDRA TIANA
Entity type:Individual
Prefix:MRS
First Name:ANIDRA
Middle Name:TIANA
Last Name:RAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 LAUDERDALE LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6282
Mailing Address - Country:US
Mailing Address - Phone:803-410-8240
Mailing Address - Fax:
Practice Address - Street 1:3245 LAUDERDALE LN
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-6282
Practice Address - Country:US
Practice Address - Phone:803-410-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101Y00000X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor