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General NPI Number Information
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NPI Number | 1699836627
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Entity Type | Organization
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Legal Business Name | CAROLINA PSYCHOLOGICAL RESOURCES
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1620 LADY ST SUITE A
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City | COLUMBIA
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State | SC
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Zip | 29201-3404
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Country | US
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Telephone | 803-252-4935
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Fax | 803-252-7658
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Provider Business Mailing Address
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Address Line | 703 KAWANA RD
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City | COLUMBIA
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State | SC
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Zip | 29205-2030
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Country | US
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Telephone | 803-254-0782
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA S GRISWOLD
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Credential | PH.D.
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Telephone | 803-252-4935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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