Provider Demographics
NPI:1629693007
Name:MASSENGALE, CHANDLER (LISW-CP)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:MASSENGALE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SYCAMORE AVE UNIT 30174
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-2708
Mailing Address - Country:US
Mailing Address - Phone:843-410-3462
Mailing Address - Fax:
Practice Address - Street 1:78 SYCAMORE AVE UNIT 30174
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29417-2708
Practice Address - Country:US
Practice Address - Phone:843-410-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical