Healthcare Provider Details

I. General information

NPI: 1003011412
Provider Name (Legal Business Name): ANNA BIRKS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE STREET
CHARLESTON SC
29401
US

IV. Provider business mailing address

109 BEE STREET
CHARLESTON SC
29401
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7316
  • Fax:
Mailing address:
  • Phone: 843-789-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: