| Dutch Fork Psychological Services | |
|
7313 College St Irmo SC 29063-2902 | |
| (803) 407-7099 | |
| (803) 807-9104 |
| Full Name | Dutch Fork Psychological Services |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 7313 College St, Irmo, South Carolina |
| Authorized Official Name and Position | William E. Haxton (OWNER) |
| Authorized Official Contact | 8034077099 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dutch Fork Psychological Services 7313 College St Irmo SC 29063-2902 Ph: (803) 407-7099 | Dutch Fork Psychological Services 7313 College St Irmo SC 29063-2902 Ph: (803) 407-7099 |
| NPI Number | 1750308409 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 04/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750308409 | NPI | - | NPPES |
| GP4164 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 654 (South Carolina) | Primary |
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