Healthcare Provider Details

I. General information

NPI: 1598706798
Provider Name (Legal Business Name): DARREL GENE SHAVER PH.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

IV. Provider business mailing address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

V. Phone/Fax

Practice location:
  • Phone: 803-731-4708
  • Fax: 803-612-1206
Mailing address:
  • Phone: 803-731-4708
  • Fax: 803-612-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1355
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: