Provider Demographics
NPI:1083073274
Name:CHINA, ANEDRA (ADC, LPC)
Entity type:Individual
Prefix:MS
First Name:ANEDRA
Middle Name:
Last Name:CHINA
Suffix:
Gender:
Credentials:ADC, LPC
Other - Prefix:MS
Other - First Name:ANEDRA
Other - Middle Name:
Other - Last Name:CHINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, ADC, LPC
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-0173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 DICK POND RD STE E
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7286
Practice Address - Country:US
Practice Address - Phone:803-470-3866
Practice Address - Fax:803-373-1541
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC21164101YM0800X
SC8303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2740Medicaid