Individual
JONATHAN MURDAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1040 TINKER TOWN RD, FAIRFAX, SC 29827-7220
(803) 686-0412
Mailing address
PO BOX 1332, FAIRFAX, SC 29827-1332
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Enumeration date
01/26/2015
Last updated
01/28/2015
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