Healthcare Provider Details

I. General information

NPI: 1194746446
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WILLIAMS STREET CONNELLY BLDG STE 104
LANCASTER SC
29720
US

IV. Provider business mailing address

PO BOX 669
LANCASTER SC
29721-0669
US

V. Phone/Fax

Practice location:
  • Phone: 803-283-4004
  • Fax: 803-283-4004
Mailing address:
  • Phone: 803-283-4004
  • Fax: 803-283-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number262
License Number StateSC

VIII. Authorized Official

Name: DR. JOSEPH PATRICK GOLDSMITH
Title or Position: PSYCHOLOGIST
Credential: ED D
Phone: 803-283-4004