Individual
DEROSSET MYERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
15 MEDICAL PARK RD, SUITE 103, COLUMBIA, SC 29203-8003
(803) 255-3400
(803) 255-3420
Mailing address
15 MEDICAL PARK RD, SUITE 103, COLUMBIA, SC 29203-8003
(803) 255-3400
(803) 255-3420
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
431
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0720
—
SC
05
—
PS0046
—
SC
Enumeration date
03/24/2006
Last updated
04/30/2008
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