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Individual

MARK E TIDSWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.ED.

Contact information

Practice address
1431 N LAKE DR, LEXINGTON, SC 29072-7651
(803) 808-9623
Mailing address
1431 N LAKE DR, LEXINGTON, SC 29072-7651
(803) 808-9623

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3858
SC

Other

Enumeration date
12/15/2006
Last updated
12/23/2008
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