Healthcare Provider Details

I. General information

NPI: 1669269213
Provider Name (Legal Business Name): SALLIE DARBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HUDSON ST
CHESTER SC
29706-1524
US

IV. Provider business mailing address

130 HUDSON ST
CHESTER SC
29706-1524
US

V. Phone/Fax

Practice location:
  • Phone: 803-377-8111
  • Fax:
Mailing address:
  • Phone: 803-377-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: