MEDICARE: CHADDRICK L MIDDLETON LPC-I, CRC, CVE

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	101Y00000X	Counselor	5466	SC

General Provider Information

NPI Number	:	1609114826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHADDRICK L MIDDLETON LPC-I, CRC, CVE

Provider Business Mailing Address
First Line	:	9367 TWO NOTCH RD
Second Line	:	SUITE F-1
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6442
Country	:	US
Telephone Number	:	803-563-5087
Fax Number	:

Provider Business Practice Location Address
First Line	:	9367 TWO NOTCH RD
Second Line	:	SUITE F-1
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6442
Country	:	US
Telephone Number	:	803-563-5087
Fax Number	:

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

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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