MEDICARE: STAUNTON GREGORY CHALK M.ED., LPC

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	101YM0800X	Mental Health Counselor	3448	SC

General Provider Information

NPI Number	:	1558583229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAUNTON GREGORY CHALK M.ED., LPC

Provider Business Mailing Address
First Line	:	1068 WILLOUGHBY LN
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9038
Country	:	US
Telephone Number	:	843-849-8222
Fax Number	:	843-744-1434

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	:	843-744-1434

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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