Individual
DR. EDMUND ANTHONY O'CONNOR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
330 BILLINGSLEY RD STE 102, CHARLOTTE, NC 28211-5055
(704) 512-7578
Mailing address
1438 EASTLAWN RD SE, EAST GRAND RAPIDS, MI 49506-4108
(616) 328-3686
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011402
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700957081
—
MI
Enumeration date
11/10/2006
Last updated
07/29/2024
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