Individual
DR. ELLEN WILFONG-GRUSH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1744 SAM RITTENBERG BLVD, SUITE C, CHARLESTON, SC 29407-4935
(843) 763-2425
(843) 571-0601
Mailing address
1569 HUTTON PL, CHARLESTON, SC 29407-3505
(843) 571-0601
(843) 571-0601
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
523
SC
Other
Enumeration date
05/13/2006
Last updated
07/08/2007
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