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Individual
CHANDY PAGE
Active
Individual
CHANDY PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
9236
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9236
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570569761
TAX ID
SC
05
—
AD01AK
—
SC
Enumeration date
11/28/2012
Last updated
05/22/2020
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