Healthcare Provider Details

I. General information

NPI: 1730525460
Provider Name (Legal Business Name): MARY BETH HILL M. ED,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CAHOUN STREET
CHARLESTON SC
29401
US

IV. Provider business mailing address

75 CAHOUN ST
CHARLESTON SC
29401
US

V. Phone/Fax

Practice location:
  • Phone: 843-852-6524
  • Fax:
Mailing address:
  • Phone: 843-852-6524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: