Healthcare Provider Details

I. General information

NPI: 1477529980
Provider Name (Legal Business Name): PHILIP J MICHELS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

IV. Provider business mailing address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

V. Phone/Fax

Practice location:
  • Phone: 804-434-6113
  • Fax: 803-434-7529
Mailing address:
  • Phone: 803-434-6113
  • Fax: 803-434-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number282
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number282
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: