Provider Demographics
NPI:1407977788
Name:SANTANA, RANDY (MA, LPC, NCC, CAC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 BIRKENHEAD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5442
Mailing Address - Country:US
Mailing Address - Phone:843-556-7827
Mailing Address - Fax:
Practice Address - Street 1:5269 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6311
Practice Address - Country:US
Practice Address - Phone:843-744-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)