Individual
CHANDY PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
116 DRIFTWOOD CIR, AIKEN, SC 29801-7273
(803) 599-2594
Mailing address
33 VARDEN DR, AIKEN, SC 29803-5285
(803) 642-3801
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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