Healthcare Provider Details

I. General information

NPI: 1417132150
Provider Name (Legal Business Name): LIVY FOGLE EBERLY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 COURTENAY DR
CHARLESTON SC
29403-5707
US

IV. Provider business mailing address

48 COURTENAY DR
CHARLESTON SC
29403-5707
US

V. Phone/Fax

Practice location:
  • Phone: 843-853-3005
  • Fax:
Mailing address:
  • Phone: 843-853-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number995
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: