Provider Demographics
NPI:1164766143
Name:STATEN, DAVID (PHD,LPC, NCC,CRC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:STATEN
Suffix:
Gender:M
Credentials:PHD,LPC, NCC,CRC
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:STATEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CRC, BCPC
Mailing Address - Street 1:244 MOUNT HOPE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-9013
Mailing Address - Country:US
Mailing Address - Phone:803-928-0523
Mailing Address - Fax:803-534-0497
Practice Address - Street 1:1031 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4783
Practice Address - Country:US
Practice Address - Phone:803-378-4443
Practice Address - Fax:803-534-0497
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional