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General NPI Number Information
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NPI Number | 1124437074
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Entity Type | Individual
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Provider Name | CHAD KRISAK ED.S., LPES, NCSP
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Gender | Male
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 2907 STONESTOWN DR
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City | CHARLESTON
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State | SC
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Zip | 29414-6690
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Country | US
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Telephone | 901-487-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 STONESTOWN DR
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City | CHARLESTON
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State | SC
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Zip | 29414-6690
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Country | US
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Telephone | 901-487-7506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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