Healthcare Provider Details

I. General information

NPI: 1376772335
Provider Name (Legal Business Name): SEASONS PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S MCQUEEN ST
FLORENCE SC
29501-4723
US

IV. Provider business mailing address

314 S MCQUEEN ST
FLORENCE SC
29501-4723
US

V. Phone/Fax

Practice location:
  • Phone: 843-407-4440
  • Fax: 843-407-4461
Mailing address:
  • Phone: 843-407-4440
  • Fax: 843-407-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1122
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1122
License Number StateSC

VIII. Authorized Official

Name: DR. ANDREA LEA PRITCHARD-BOONE
Title or Position: PRESIDENT
Credential: PHD
Phone: 843-407-4440