Individual
DR. SHAWNA BLAKE KIRBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1505 CHARLESTON HWY, # 1523, WEST COLUMBIA, SC 29169-5069
(803) 497-3640
(888) 352-7678
Mailing address
1505 CHARLESTON HWY, # 1523, WEST COLUMBIA, SC 29169-5069
(803) 995-1838
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1251
SC
103TC0700X
Clinical Psychologist
1251
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0613
—
SC
Enumeration date
12/18/2006
Last updated
02/28/2024
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