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General NPI Number Information
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NPI Number | 1669717930
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Entity Type | Individual
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Provider Name | CHANDY PAGE LISW
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 116 DRIFTWOOD CIR
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City | AIKEN
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State | SC
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Zip | 29801-7273
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Country | US
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Telephone | 803-599-2594
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Fax |
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Provider Business Mailing Address
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Address Line | 33 VARDEN DR
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City | AIKEN
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State | SC
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Zip | 29803-5285
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Country | US
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Telephone | 803-642-3801
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9236
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9236
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License Number State | SC
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