Healthcare Provider Details

I. General information

NPI: 1336447952
Provider Name (Legal Business Name): CHARLESTON PSYCHOLOGICAL ASSOC. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 OLD GEORGETOWN RD SUITE B
MT PLEASANT SC
29464-7307
US

IV. Provider business mailing address

1341 OLD GEORGETOWN RD SUITE B
MT PLEASANT SC
29464-7307
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-9870
  • Fax: 843-216-9872
Mailing address:
  • Phone: 843-216-9870
  • Fax: 843-216-9872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number320
License Number StateSC

VIII. Authorized Official

Name: DR. WILLIAM G. KEE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 843-216-9870