Healthcare Provider Details

I. General information

NPI: 1225308448
Provider Name (Legal Business Name): THELVANESA MURPHY SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 SMALLWOOD RD UNIT 202
COLUMBIA SC
29223-3232
US

IV. Provider business mailing address

4824 SMALLWOOD RD UNIT 202
COLUMBIA SC
29223-3232
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-4532
  • Fax:
Mailing address:
  • Phone: 803-708-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4585
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4585
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4585
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number4585
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: