Healthcare Provider Details

I. General information

NPI: 1457568107
Provider Name (Legal Business Name): CLINICAL ASSOCIATES OF HILTON HEAD,P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OFFICE PARK RD SUITE 208
HILTON HEAD ISLAND SC
29928-4654
US

IV. Provider business mailing address

21 OFFICE PARK RD SUITE 208
HILTON HEAD ISLAND SC
29928-4654
US

V. Phone/Fax

Practice location:
  • Phone: 843-842-5526
  • Fax: 843-842-4764
Mailing address:
  • Phone: 843-842-5526
  • Fax: 843-842-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number#283
License Number StateSC

VIII. Authorized Official

Name: DR. MARION V. O'NEILL
Title or Position: PRESIDENT
Credential: PH.D
Phone: 843-842-5526