Organization
CAROLINA NEUROBEHAVIORAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE MICHAEL WEST PH.D (OWNER)
(843) 413-0303
Entity
Organization
Contact information
Practice address
1504 HERITAGE LN, FLORENCE, SC 29505-3141
(843) 413-0303
(843) 413-0340
Mailing address
1504 HERITAGE LN, FLORENCE, SC 29505-3141
(843) 413-0303
(843) 413-0340
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
000664
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609850825
—
SC
Enumeration date
02/01/2011
Last updated
02/01/2011
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