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General NPI Number Information
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NPI Number | 1225298698
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Entity Type | Organization
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Legal Business Name | JEROME HANLEY
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 1919 GADSDEN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2346
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Country | US
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Telephone | 803-779-5356
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40105
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City | COLUMBIA
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State | SC
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Zip | 29240-0105
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Country | US
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Telephone | 803-741-5598
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JEROME H HANLEY
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Credential | PH.D
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Telephone | 803-741-5598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 280
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License Number State | SC
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