MEDICARE: SCARLET CHANCEY LPC, CADCII, ACS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CADCII1364	GA
2	101YP2500X	Professional Counselor	LPC012915	GA
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730433079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCARLET CHANCEY LPC, CADCII, ACS

Provider Business Mailing Address
First Line	:	PO BOX 757
Second Line	:
City	:	GUYTON
State	:	GA
Zip	:	31312-0757
Country	:	US
Telephone Number	:	912-977-0529
Fax Number	:	912-500-2970

Provider Business Practice Location Address
First Line	:	345 W MEMORIAL DR
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-2413
Country	:	US
Telephone Number	:	912-456-2010
Fax Number	:	912-456-2011

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

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	02/12/2025

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