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General NPI Number Information
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NPI Number | 1710120233
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Entity Type | Individual
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Provider Name | WILLIAM COLDEN O'LEARY JR. PH. D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 4988 HEREFORD FARM RD
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City | EVANS
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State | GA
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Zip | 30809-6006
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Country | US
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Telephone | 706-860-2438
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 8052
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City | NORTH AUGUSTA
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State | SC
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Zip | 29861
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Country | US
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Telephone | 706-755-6211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 177
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License Number State | SC
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