Healthcare Provider Details

I. General information

NPI: 1821299348
Provider Name (Legal Business Name): EMILY VAN BUREN MULCAHY PSYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94A MAIN ST
HILTON HEAD SC
29926-1685
US

IV. Provider business mailing address

2 SHELTER COVE LN #249
HILTON HEAD SC
29928-1512
US

V. Phone/Fax

Practice location:
  • Phone: 843-338-9619
  • Fax:
Mailing address:
  • Phone: 843-338-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number000806
License Number StateSC

VIII. Authorized Official

Name: MRS. EMILY VAN BUREN MULCAHY
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 843-338-9619