Provider Demographics
NPI:1487852174
Name:DIGIANDOMENICO, CHRIS (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:DIGIANDOMENICO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:SUITE4
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6439
Mailing Address - Country:US
Mailing Address - Phone:843-871-4790
Mailing Address - Fax:843-871-8579
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE4
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6439
Practice Address - Country:US
Practice Address - Phone:843-871-4790
Practice Address - Fax:843-871-8579
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5709101YA0400X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD16DOMedicaid