Organization
FRANCIS MARION UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE LEA FORTHMAN (CREDENTIALING MANAGER)
(270) 557-6396
Entity
Organization
Contact information
Practice address
201 W EVANS ST, FLORENCE, SC 29501-3427
(843) 661-1721
Mailing address
PO BOX 100547, FLORENCE, SC 29502-0547
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
01/29/2021
Last updated
04/07/2021
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