Provider Demographics
NPI:1295177939
Name:WENDY CHANEY, LLC
Entity type:Organization
Organization Name:WENDY CHANEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:ED S, LMFT
Authorized Official - Phone:864-901-8845
Mailing Address - Street 1:502 N. JENNINGS ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138
Mailing Address - Country:US
Mailing Address - Phone:864-901-8845
Mailing Address - Fax:864-803-0113
Practice Address - Street 1:345 PRADO WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-901-8845
Practice Address - Fax:864-803-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLNFT4320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLT1004Medicaid