Provider Demographics
NPI:1558583229
Name:CHALK, STAUNTON GREGORY (MED, LPC)
Entity Type:Individual
Prefix:
First Name:STAUNTON
Middle Name:GREGORY
Last Name:CHALK
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 WILLOUGHBY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9038
Mailing Address - Country:US
Mailing Address - Phone:843-849-8222
Mailing Address - Fax:843-744-1434
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:843-744-1434
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health