Individual
OBATALA OMBU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
209 SHORT ST, KINGSTREE, SC 29556-3926
(843) 372-5959
(843) 355-7746
Mailing address
PO BOX 697, KINGSTREE, SC 29556-0697
(843) 355-2772
(843) 355-7746
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
Primary
—
—
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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