Provider Demographics
NPI:1609114826
Name:MIDDLETON, CHADDRICK L (LPC-I, CRC, CVE)
Entity Type:Individual
Prefix:
First Name:CHADDRICK
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:LPC-I, CRC, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9367 TWO NOTCH RD
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6442
Mailing Address - Country:US
Mailing Address - Phone:803-563-5087
Mailing Address - Fax:
Practice Address - Street 1:9367 TWO NOTCH RD
Practice Address - Street 2:SUITE F-1
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6442
Practice Address - Country:US
Practice Address - Phone:803-563-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5466101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor