Provider Demographics
NPI:1992323166
Name:DRAYTON, DEITRICH ANDERA (MS)
Entity type:Individual
Prefix:
First Name:DEITRICH
Middle Name:ANDERA
Last Name:DRAYTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3820
Mailing Address - Country:US
Mailing Address - Phone:803-606-9661
Mailing Address - Fax:
Practice Address - Street 1:517 HOWARD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3820
Practice Address - Country:US
Practice Address - Phone:803-606-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health