=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790698983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANAYA CARR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 COATBRIDGE DR
-----------------------------------------------------
City | BLYTHEWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29016-9168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-7191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 COATBRIDGE DR
-----------------------------------------------------
City | BLYTHEWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29016-9168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-7191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 1-23-314419
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------