MEDICARE: DR. CALVIN BRYAN VACCHIO SR. PH.D., NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5523	SC

General Provider Information

NPI Number	:	1134557887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN BRYAN VACCHIO SR. PH.D., NCC, LPC

Provider Business Mailing Address
First Line	:	208 HILLWICK DR
Second Line	:
City	:	GASTON
State	:	SC
Zip	:	29053-8832
Country	:	US
Telephone Number	:	803-240-8841
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 FOREST DR STE C
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4146
Country	:	US
Telephone Number	:	803-403-8469
Fax Number	:	803-403-9979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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