| NPI | 1447709431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNA BLAKE KIRBY Clinical Psychologist 803-708-9638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 1251) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1251) |
| Enumeration Date | 2016-10-02 |
| Last Update Date | 2019-05-03 |