Healthcare Provider Details

I. General information

NPI: 1073429700
Provider Name (Legal Business Name): SHANDRA R. DRAYTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OHEAR AVE
CHARLESTON SC
29405-4986
US

IV. Provider business mailing address

2264 ANDOVER WAY
MT PLEASANT SC
29466-7053
US

V. Phone/Fax

Practice location:
  • Phone: 317-340-7779
  • Fax:
Mailing address:
  • Phone: 317-340-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12467
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: