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General NPI Number Information
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NPI Number | 1376772335
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Entity Type | Organization
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Legal Business Name | SEASONS PSYCHOLOGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 314 S MCQUEEN ST
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City | FLORENCE
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State | SC
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Zip | 29501-4723
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Country | US
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Telephone | 843-407-4440
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Fax | 843-407-4461
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Provider Business Mailing Address
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Address Line | 314 S MCQUEEN ST
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City | FLORENCE
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State | SC
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Zip | 29501-4723
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Country | US
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Telephone | 843-407-4440
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Fax | 843-407-4461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA LEA PRITCHARD-BOONE
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Credential | PHD
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Telephone | 843-407-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1122
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1122
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License Number State | SC
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