MEDICARE: RANDY SANTANA M.A., LPC, NCC, CAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	3201	SC

General Provider Information

NPI Number	:	1407977788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY SANTANA M.A., LPC, NCC, CAC

Provider Business Mailing Address
First Line	:	2528 BIRKENHEAD DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5442
Country	:	US
Telephone Number	:	843-556-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	5269 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6311
Country	:	US
Telephone Number	:	843-744-1447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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